Adjustment Experiences of Zimbabwean International Students Studying in the United States and Their Perception of United States Mental Health Counseling

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ADJUSTMENT EXPERIENCES OF ZIMBABWEAN INTERNATIONAL STUDENTS STUDYING IN THE UNITED STATES AND THEIR PERCEPTION OF UNITED STATES MENTAL HEALTH COUNSELING

A dissertation submitted to the Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Doctor of Philosophy

Emily E. Mupinga

May 2018

ii A dissertation written by

Emily E. Mupinga

A.S., Gweru Teachers’ College, Zimbabwe, 1989

B.S., Louisiana State University, 1998

M.S., Louisiana State University, 1999

M.S., Indiana State University, 2006

Ph.D., Kent State University, 2018

Approved by

______, Co-Director, Doctoral Dissertation Committee Jane A. Cox

______, Co-Director, Doctoral Dissertation Committee Lynne Guillot Miller

______, Member, Doctoral Dissertation Committee Martha C. Merrill

Accepted by

______, Director, School of Lifespan Development and Mary Dellmann-Jenkins Educational Sciences

______, Dean, College of Education, Health and Human James C. Hannon Services

iii

MUPINGA EMILY E., Ph.D., May 2018 COUNSELOR EDUCATION AND SUPERVISION

ADJUSTMENT EXPERIENCES OF ZIMBABWEAN INTERNATIONAL STUDENTS IN THE UNITED STATES AND THEIR PERCEPTIONS OF UNITED STATES MENTAL HEALTH COUNSELING (210 pp.)

Co-Directors of Dissertation: Jane A. Cox, Ph.D. Lynne Guillot Miller, Ph. D.

This study aimed at understanding the adjustment experiences of Zimbabwean international students as they study in the United States and exploring their perception of

United States mental health counseling. Qualitative inquiry (basic interpretive approach) was selected as the research method due to the explorative nature of the research questions. Nine participants were recruited using the snowball sampling method and the

United States was the only foreign country in which they had been college or university students. The following research questions guided the study: (a) What are the adjustment experiences of Zimbabwean international students as they study in the United States? (b)

What are the Zimbabwean international students’ perception of United States mental health counseling? Semi-structured interviews were used to collect data. NVivo, a

Qualitative Data Analysis (QDA) computer software, was used to manage the data. Five overarching themes emerged from the data analysis: (a) limited resources, (b) navigating the United States’ academic environment, (c) socio-cultural barriers, (d) limited exposure to United States mental health counseling, and (e) self-reliance and informal supports leading to acclimation. These findings were comparable to results of previous studies and they have important implications for higher education, counselor educators, college

clinical mental health counselors, and Zimbabwean international students (both prospective and current).

ACKNOWLEDGMENTS

First, I would like to thank God Almighty for His faithfulness, and the many blessings He bestowed upon me along the way. What a meandering route but incredible journey!

I would like to acknowledge and thank everyone who supported me, in any respect, during the completion of my doctoral work. This includes my coursework advisors (Dr. Jason McGlothlin and Dr. Marty Jencius), the Counselor Education &

Supervision faculty and staff at Kent State University, my classmates, workmates, and friends.

My special thanks to the nine Zimbabwean international students who participated in this research. Thank you for sharing your experiences and insights.

I am heartily thankful to my dissertation co-advisors, Dr. Jane Cox and Dr. Lynn

Guillot Miller for their guidance, encouragement, feedback, and time. Your expertise and hard work are greatly appreciated. I am grateful to Dr. Martha Merrill and Dr. Karla

Anhalt for taking time away from their busy schedules to serve on my dissertation committee and for offering great support. Thanks, Penny Minor, for being a great friend and a tireless cheerleader. The many valuable discussions and email messages we exchanged over the years kept me motivated to complete this project.

I also would like to acknowledge my siblings (Ben [late], Stephen, Charmpeh,

Loveness, & Stewart) and their spouses; my nieces and nephews; my aunts and uncles; and my cousins and their families. Thank you for being a constant source of support and

strength all these years. Mom and Dad [late], thanks for your love, blessings, and incredible prayers that kept me going. I love you!

Finally, I am so blessed and grateful for the unconditional love, encouragement, and patience of my beloved husband and best friend, Davison and my wonderful children

(Rumbie, Tanaka, and Blessing). Thanks for believing in me and I love you so much!

TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS ...... iv

LIST OF TABLES ...... ix

CHAPTER

I. INTRODUCTION TO THE STUDY AND REVIEW OF LITERATURE...... 1 Overview ...... 1 Research Question ...... 5 Purpose of Study ...... 5 Review of Literature ...... 6 International Students in the United States ...... 9 Adjustment problems experienced by international students...... 10 English language and academic problems ...... 10 Discrimination...... 15 Homesickness and loneliness ...... 18 Conflicting cultural values ...... 20 International students’ perception of professional mental health counseling ...... 29 Zimbabwe: An Overview ...... 33 Demographics ...... 34 Political and Economic History ...... 34 Education System ...... 38 Cultural Explanations of the Causes of Mental Health Problems in Zimbabwe ...... 41 Belief in the Power of Ancestral Spirits ...... 42 Belief in the Power of Witchcraft ...... 43 Belief in the Power of Demons ...... 44 Mental Health Care and Healing Methods in Zimbabwe ...... 45 Family Caregiving ...... 46 Modern Mental Health Care ...... 47 Traditional Mental Health Care ...... 48 Christian-Faith Healing ...... 51 Chapter Summary ...... 51

II. METHODOLOGY ...... 53 Research Design...... 53 Description of Researcher and Assumptions ...... 56 Sample...... 60 Data Collection ...... 63 vi

Demographic Questionnaire ...... 64 Interviews ...... 64 Data Analysis ...... 70 Coding...... 71 Categorization ...... 73 Theme Exploration...... 74 Trustworthiness ...... 77 Member Checking ...... 77 Memos ...... 78 Reflexivity ...... 79 Peer Review ...... 80 Ethical Considerations ...... 81 Chapter Summary ...... 82

III. RESULTS ...... 83 Participants’ Demographics ...... 84 Core Themes ...... 84 Theme 1: Limited Resources ...... 85 Finances...... 85 Housing ...... 88 Food ...... 89 Transportation ...... 90 Support system ...... 91 Theme 2: Navigating the United States’ Academic Environment ...... 93 Teaching approaches ...... 93 Academic expectations...... 97 Classroom behavior ...... 99 Technology ...... 100 Relationship with professors ...... 101 Theme 3: Socio-Cultural Barriers ...... 102 Language ...... 102 Cultural practices ...... 104 Theme 4: Limited Exposure to United States Mental Health Counseling ...... 108 Theme 5: Self-Reliance and Informal Supports Leading to Acclimation ...... 111 Chapter Summary ...... 117

IV. DISCUSSION ...... 119 Summary of Findings in Relation to Previous Literature ...... 120 Limited Resources ...... 121 Navigating the United States’ Academic Environment ...... 125 Socio-Cultural Barriers ...... 129 Limited Exposure to United States Mental Health Counseling ...... 133 vii

Self-Reliance and Informal Supports Leading to Acclimation ...... 135 Implications...... 137 Implications for Higher Education ...... 138 Implications for Counselor Educators and Other University Faculty ...... 143 Implications for Clinical Mental Health Counselors ...... 148 Implications for Prospective and Current Zimbabwean International Students...... 151 Limitations of this Study ...... 154 Directions for Future Research ...... 155 Conclusion ...... 156

APPENDICES ...... 158 APPENDIX A. IRB APPROVAL FORM ...... 159 APPENDIX B. RECRUITMENT LETTER ...... 161 APPENDIX C. INFORMED CONSENT LETTER TO PARTICIPANTS ...... 163 APPENDIX D. DEMOGRAPHICS QUESTIONNAIRE ...... 168 APPENDIX E. FIRST INTERVIEW QUESTIONS ...... 170 APPENDIX F. SECOND INTERVIEW QUESTIONS ...... 172 APPENDIX G. AUDIO RECODINGS ...... 174 APPENDIX H. MEMBER CHECKING LETTER ...... 176 APPENDIX I. PEER REVIEWER LETTER ...... 178

REFERENCES ...... 180

viii

LIST OF TABLES

Table Page

1. Participant’s Demographic Information (1) ...... 65

2. Participant’s Demographic Information (2) ...... 66

3. Data Collection and Analysis Process (1) ...... 69

4. Data Collection and Analysis Process (2) ...... 70

5. Sample of Interview Excerpts, Codes, and Meaning ...... 72

CHAPTER I

INTRODUCTION TO THE STUDY AND REVIEW OF LITERATURE

Overview

The United States’ colleges and universities have increasingly become culturally diverse due to the influx of international students from all over the world (Institute of

International Education, 2013). For most of these students, being in a foreign college or university is associated with unique transitional challenges such as constant pressure to acculturate (Duru & Poyrazli, 2007); adjusting to a new education system and a new language (Institute of International Education, 2013); loss of social status; and immigration concerns (Wang & Mallinckrodt, 2006). Some international students have reported financial distress (Mutai, 2008; National Association of Foreign Student

Advisers, 2011); academic problems (Willis, Stroebe, & Hewstone, 2003; Zhai, 2004); discrimination (Constantine, Anderson, Berkel, Caldwell, & Utsey, 2005; Hanassab,

2006; Poyrazli & Lopez, 2007); limited support systems (Mori, 2002; Sümer, Poyrazli, &

Grahame, 2008; Mutai, 2008); and homesickness (Araujo, 2011; Constantine, Kindaichi,

Okazaki, Gainor, & Baden, 2005). Others have reported problems associated with differences in food, weather, and time zones (Johanson, 2010); and distress associated with efforts to maintain their own cultural identity (Sue & Sue, 2008). In addition, personal crises happening at home (such as illness or death among family members and friends, and parental discord or divorce) and management of these crises, especially when students are unable to go home, can produce a tremendous amount of stress (Mori, 2002).

These unique challenges make international students more vulnerable to social,

1 2 emotional, relational, and psychological problems than their fellow American students

(Galloway & Jenkins, 2009). If not addressed, these challenges can result in declining academic performance, withdrawal from school, substance abuse, and physical deterioration of international students (National Institute of Mental Health [NIMH],

2012; Vogel, Wade, & Wester, 2007). International students may need help adjusting to life in a foreign country and one of the identified support systems is professional mental health counseling (Nina, 2009).

International students underuse mental health services even though they tend to experience more problems than students in general and seem to have an urgent need for psychological assistance (Mori, 2000). It is important to understand that cultural differences in perceptions of and reactions to stressors may determine the coping strategies that international students use (Onabule & Boes, 2013). For example, some international students perceive psychosomatic complaints as medical concerns (Mori,

2002) and feel more comfortable seeking medical care services rather than mental health services (Nina, 2009; Onabule & Boes, 2013) whereas others prefer to seek help from friends and family (Constantine, Anderson, et al., 2005; Zhai, 2004). It is interesting to note that students of Western origin (for example, European and Latin American) are more likely to seek help from a counseling professional than non-Western international students from Africa, Asia, and the Middle-East (Araujo, 2011; Mortenson, 2006;

Onabule & Boes, 2013).

Literature suggests several reasons that inhibit international students from seeking professional help. Most of them lack knowledge about or misunderstand professional

3 counseling services because of the stigma associated with mental health problems (A. W.

Chen, Kazanjian, & Wong, 2009; Constantine, Okazaki, & Utsey, 2004). Some are fearful of disclosing personal information to strangers, or want to avoid the embarrassment that may result if their families became aware that they were seeking professional counseling (Komiya, Good, & Sherrod, 2000). Others lack trust in the helping professionals (Araujo, 2011). The few international students who seek professional help face challenges associated with trying to understand and to accept mental health services with which they may be unacquainted (Ahmed, Wilson,

Henriksen, & Jones, 2011; Araujo, 2011). As a result, following through with treatment may be complicated by differences between international students’ and United States’ cultural understanding of causes and treatment of mental health problems. Because these cultural differences seem to be the core of counseling interactions, mental health professionals in the United States need to enhance knowledge of their international clients’ cultures so that cultural barriers are narrowed.

Even though efforts are being made toward multicultural practice, most clinicians in the United States seem to be grounded in Western theory (Poyrazli & Kavanaugh,

2006), and, as such, their practice may be incongruent with important cultural factors that impact counseling and the counseling relationship with Non-Western clients (Araujo,

2011). Such counselors may use a one-dimensional cultural perspective and may disregard or minimize cultural differences. This approach may be problematic because it is based on the values of the White middle class (Ponterotto, Utsey, & Pedersen, 2006;

Sue & Sue, 2008) and does not incorporate values and beliefs of other cultural groups.

Consequently, the approach may not appropriately meet the unique needs of culturally different clients. Mental health counselors, therefore, need to develop and use multicultural competent skills to effectively work with their international college clients

(American Counseling Association [ACA], 2014). This means multi-culturally competent counselors approach the counseling process from the context of the personal culture of the client. Such counselors do not impose their cultural values on clients (Sue

& Sue, 2008) and should reject the American assumption that the “melting pot” of assimilation will level out major cultural differences (Jacoby, 2004). Understanding international students’ unique adjustment experiences and their cultural perceptions of professional mental health services in the United States may help counselors gain insight into the critical elements of their international clients’ mental health issues, recognize the influence of cultural contexts, and improve counseling services.

There is a plethora of studies on adjustment issues of international students, and these studies have been primarily conducted with Asian and Hispanic students (Komiya

& Eells, 2011; Komiya et al., 2000; Zhai, 2004). Perceptions of international students about mental health counseling have also been conducted with mostly Asian students but the studies are very few (Ng & Smith, 2009; Peiwei, Wong, & Toth, 2013; Xie, 2008).

There is clearly a dearth of literature on African students, particularly those from

Zimbabwe. Zimbabwean international students seem to be an overlooked population due to their smaller numbers in comparison to other international student groups (Institute of

International Education, 2014). Regardless, they represent a unique culture and

5 therefore, their cultural idiosyncrasies need to be understood so that stereotyping and overgeneralization of their experiences are avoided.

Research Question

The following questions are explored in the present research study:

1. What are the adjustment experiences of Zimbabwean international students as

they study in the United States?

2. What are the Zimbabwean international students’ perceptions of United States

mental health counseling?

Purpose of Study

The purpose of this study is to understand the adjustment experiences of

Zimbabwean international students as they study in the United States and explore their perceptions of United States mental health counseling. This study is important for several reasons. First, there is a gap in literature concerning research with Zimbabwean students. To date, there is no study that has sought to understand Zimbabwean international students’ adjustment experiences and their perceptions of professional mental health counseling. It is important to understand that international students are a heterogeneous group comprised of students from different countries (e.g., Western vs. non-Western, developing vs. developed countries) and as diverse as they are, so are their perceptions and their experiences. Therefore, in order to avoid overgeneralizations, there is a need to focus on international students from specific countries.

Second, there is a need to conduct more qualitative studies on international students because most studies are quantitative in nature (Al-Darmaki, 2011; Zhang &

Dixon, 2003). Quantitative studies are well suited for testing existing theories and hypotheses, and examining cause and effect relationships using predetermined variables

(Creswell, 2009). Data collection, analysis, and interpretation are reduced to and mostly reported in numbers (Stanfield, 2006). Quantitative research does not regard the subjective state of a situation or of participants (Patton, 2005). In contrast, qualitative studies focus on exploring participants’ perceptions and experiences and the way they make sense of their experiences (Anderson & Taylor, 2009). Qualitative studies take into consideration cultural contexts of participants’ experiences, are concerned with process rather than outcomes, and report detailed descriptions of participants’ experiences

(Patton, 2005).

Third, this study will contribute to the counseling profession by adding new knowledge to existing literature on mental health topics associated with international students from Zimbabwe as well as providing mental health professionals with new insights concerning effective multi- and cross-cultural work with diverse populations.

This study will also provide the counseling profession with a framework for developing viable counseling programs and services likely to enable international students cope with challenges related to studying in a foreign country.

Review of Literature

The last two decades have seen an increased awareness of the importance of respecting cultural differences in counseling and the focus has been on United States minority groups who differ from what is considered to be typically American, but who live within the American culture (Ahmed et al., 2011; Sue & Sue, 2008). However, for

7 international students, cultural differences are more evident (C. C. Lee & Park, 2013; Sue

& Sue, 2008), and their presence in the United States has helped raise interest among mental health scholars and practitioners regarding multicultural competence in training and service delivery (ACA, 2014). The counseling profession, therefore, is taking big strides to shift from monocultural to multicultural practice (Chao, Wei, Good, & Flores,

2011). Monocultural practice occurs when a one-dimensional cultural perspective describes reality and cultural differences are disregarded or minimized (Hartung, 2011).

In addition, those ascribing to this practice believe in the inferiority of all other groups’ life styles and cultural heritage, and the dominant group has the power to impose their standards and beliefs upon the less powerful group (Keith, 2011). Conversely, multicultural practice considers culture-specific awareness and knowledge, and infuses multicultural skills into counseling interactions (Arredondo & Toporek, 2004). Sue and his colleagues (2012) provided a comprehensive description of multiculturalism:

It values cultural pluralism, values diversity, and is a national resource and

treasure. It is about social justice, cultural democracy, and equity. It helps us

acquire the attitudes, knowledge, and skills needed to function effectively in a

pluralistic society. It includes diversity in race, class, gender, ethnicity, sexual

orientation, and so on. It involves our willingness to explore both the positive and

negative aspects of all groups. It is an essential component of analytical thinking

and challenges us to study multiple cultures, and to develop multiple perspectives.

It is about a commitment to change social conditions that deny equal access and

opportunities (social justice). It means change at the individual, institutional, and

societal levels. (p. 1)

In 1995, the counseling profession endorsed multicultural competency standards developed by Sue, Arredondo, and McDavis in 1992. Sue and his colleagues proposed that clinicians need to: (a) be aware of cultural differences that can be potential barriers to counseling, (b) possess culture-specific knowledge about themselves and their clients, and (c) develop skills applicable to working with clients from diverse cultures. These competency standards were developed from a contextual and lived-experience perspective that validated different ways of developing knowledge, practicing ethical counseling, and demonstrating competence (Arredondo & Toporek, 2004; Chao et al.,

2011). Culturally competent counselors are expected to be open to the values, norms, and cultural heritage of all clients and expected not to impose their values and beliefs on clients (Sue & Sue, 2008). The mental health profession, therefore, needs to continuously make efforts to understand cultural factors that influence counseling and encourage clinicians to include these factors in the counseling process with the intent of tailoring services to meet the clinical needs of culturally different clients, including international students (Arredondo & Toporek, 2004; Sue & Sue, 2008). In an effort to understand the presence and diversity of international students in United States’ colleges and universities, a brief description of international students studying in the United States is given in the next section.

International Students in the United States

International students enrich the United States’ college and university communities by expanding intellectual, ethnic, and cultural experiences (Institute of

International Education, 2013). In spite of the many challenges they face, international students have demonstrated perseverance and resiliency with regards to their adjustment to life in a foreign country (Araujo, 2011; Zhai, 2004).

Nearly 4% of all students enrolled in higher education in the United States are international students (Institute of International Education, 2014). This rate makes the

United States the world’s main host for international students (United Nations

Educational, Scientific and Cultural Organization [UNESCO], 2013). During the

2012/2013 academic year, 819,644 international students were enrolled in American colleges and universities, a 7.2% increase from the 2011/2012 academic year (Institute of

International Education, 2014). The highest number of these students came from China,

India, South Korea, Saudi Arabia, and Canada and they comprised 56% of all international students studying in the United States (Institute of International Education,

2014). Out of the 30,585 Sub-Saharan Africa students studying in the United States’ colleges and universities during the 2012/2013 academic year, 1,170 came from

Zimbabwe (Campus Explorer, 2013).

Despite their low numbers, it is essential to explore Zimbabwean international students’ adjustment experiences and their perceptions of professional mental health counseling in order to help them work through psychological issues associated with studying abroad. Such a study has not been conducted exclusively with Zimbabwean

10 students. The following section, therefore, highlights literature on adjustment problems experienced by international students from other countries.

Adjustment problems experienced by international students. Many international students are academic stars in their home country and when they study abroad, they become emotionally and psychologically challenged when they are no longer the superior students in foreign universities (Sovic, 2008). Their unfamiliarity with United States’ education systems, for example, can negatively affect their academic performance due to different educational requirements, expectations, teaching, and testing styles (Mori, 2002). Furthermore, academic performance pressures from families and sponsoring organizations may add to international students’ adjustment stress (Bista,

2011). The following adjustment problems were cited most frequently and were found to be associated with the most profound transitional challenges experienced by many international students: (a) English language and academic problems, (b) discrimination,

English language and academic problems. Although, the majority of international students choose to study in the United States due to less academic opportunities offered in their countries of origin (Constantine, Anderson, et al., 2005), there is often anxiety and worry about lack of understanding and misinterpreting of the

English language used as the medium of all instruction in United States’ colleges and universities (Bista, 2011; Mori, 2002). Most of the language difficulties are due to differences in accent, enunciation, slang, and use of special English words (Zhai, 2004).

The language problem can also indirectly increase the workload burden of international

11 students as it may take more time for them to study due to the difficulty of absorbing the material in a foreign language (Bista, 2011). The amount of time and work required to read, write, listen, and communicate in another language can be stressful (Gu, 2011).

Many international students may be less willing to participate in learning activities because they may not be able to express themselves clearly in English, even though they may have good ideas (Kitano, 2001). Academic work requires that reading, listening, speaking, writing papers, and taking exams be done in English. This can be a daunting task for international students since many of them have weak English skills at the outset (Bista, 2011). In addition, fast-paced instructor-student interactions and unclear role expectations were found to contribute to poor academic performance (Hahn,

2011). Further, international students may be treated as less intelligent by their professors and peers due to their accents or difficulty expressing thoughts and this can lead to anxiety and low self-esteem (Ryan, 2005; Terui, 2011).

English language problems among international students have been studied extensively; for example, Yeh and Inose (2003) investigated the influence of age, gender, region, English fluency, social connectedness, and social support network in predicting acculturative stress among a sample of 359 international students from Europe (16.9%),

Asia (61%), Central/Latin America (10.8%), North America (3%), Africa (7.8%), and

Oceania (.5%). Participants completed a demographic questionnaire, the Acculturative

Stress Scale for International Students (ASSIS) that assessed adjustment problems, the

Social Connectedness Scale (SCS) that assessed the level of interpersonal closeness experienced in their social world as well as the level of difficulty in maintaining this

12 sense of closeness, and the Social Support Questionnaire-Short Form (SSQSR) that assessed perceived social support. Stepwise regression analyses indicated that English language fluency was a significant predictor of acculturative distress. Specifically, higher frequency of use, fluency level, and the degree to which participants felt comfortable speaking English predicted lower levels of acculturative distress among international students in the sample. These results suggest that lower English fluency may be related to higher levels of acculturative distress.

In another study, Poyrazli and Kavanaugh (2006) assessed the relationship between marital status, ethnicity, academic achievement, and adjustment strains experienced by 149 graduate international students from Asia (62%), Europe (20%),

Middle East (9%), Latin America (5%), and Africa (2%). Participants completed a demographic questionnaire and the Inventory of Student Adjustment Strain (ISAS).

Adjustment strain was defined as difficulties encountered by participants in the United

States’ education system (Education subscale); difficulties experienced with the English language (English subscale); global difficulties such as differences in food, or concern with deteriorating health (Problem subscale); personal experiences that could pose problems (Personal subscale); and social practices that were troublesome for participants

(Social subscale). Besides providing an adjustment strain level for each of these subscales, the instrument also gives a general adjustment strain level. Multiple regression analyses indicated that English proficiency predicted students’ level of academic achievement and educational adjustment strain. This means that students with lower levels of English proficiency had lower levels of academic achievement and more overall

13 adjustment strain. Similarly, Swagler and Ellis (2003) investigated the cross-cultural adjustment of 96 Taiwanese graduate students using a semi-structured interview protocol, with open-ended questions. Results indicated that apprehension about speaking English affected the adjustment of international students.

Poyrazli, Kavanaugh, Baker, and Al-Timini (2004) investigated the salient variables that predicted acculturative stress among 141 international students (24%

European, 55% Asian, 3% Middle Eastern, 10% Latino, 1% African; and 7% “other” category). Participants completed a demographics questionnaire, the Personal Resource

Questionnaire-2000 (PRQ-2000) that measured social support, and the Acculturative

Stress Scale for International Students. Bivariate correlations and analyses of variance

(ANOVAs) were used to analyze the data. Results indicated that English proficiency uniquely contributed to the variance in students’ acculturative stress. This means that students with higher levels of English proficiency experience lower levels of acculturative stress. It appears that students with lower levels of English proficiency experienced higher levels of acculturative stress.

In yet another study, Dao, Lee, and Chang (2007) examined the relationship between acculturation, perceived English fluency, social support, and depression among

112 graduate Taiwanese international students. Participants completed the Self-Reported

Fluency of English Scale (SRFES), which assessed participants’ perception of their

English fluency, the Social Support Questionnaire-Short Form (SSQSR) that assessed perceived social support, the Suinn-Lew Asian Self-Identity Acculturation Scale

(SL-Asia) that assessed Asian acculturation level, and the Center for Epidemiologic

Studies Depression Scale (CES-D) that assessed symptoms of depression. Ordinary

Least Squares (OLS) analyses were conducted and results suggested that perceived

English fluency had a negative and significant association with depression. This means that international students with lower perceived English fluency were at risk of depressive feelings. Furthermore, in a cross-sectional, exploratory study, Sümer et al.

(2008) investigated how gender, age, length of stay, social support, English proficiency, and race/ethnicity contributed to both depression and anxiety for 440 international students (68% Asian, 16% White/non-Latino, 4% Latino, 3% Middle Eastern, 2% Black, and 7% who identified themselves as “other”). Participants completed the Goldberg

Depression Scale (GDS) that measured depression, the State Anxiety scale (Form Y-1) of the State-Trait Anxiety Inventory (STAI) that measured anxiety, the Social Provisions

Scale (SPS) that measured social support, and a demographic scale. Pearson product-moment correlation and hierarchical regression analyses indicated that English language significantly contributed to the variance in depression and anxiety; international students with lower levels of English proficiency reported higher levels of depression and anxiety.

It seems apparent that, overall, inadequate English language skills contribute to academic and mental health problems among international students. The reviewed literature also seems to suggest that lack of English language proficiency may create negative feelings about international students’ ability to be successful in their new environment.

Discrimination. Another prevalent problem faced by international students on

United States’ college and university campuses is ethnic and racial discrimination

(Rankin & Reason, 2005). As discussed by S. Nieto (2004), discrimination denotes negative or destructive behaviors that can result in denying some groups’ life necessities as well as the privileges, rights, and opportunities enjoyed by other groups. The effects of discrimination or perceived discrimination are varied but typically negative and can result in identity problems, depression and anxiety (Leong & Ward, 2000), feelings of loneliness and alienation (Stroebe, van Vliet, Hewstone, & Willis, 2002), and low self-esteem (Schmitt, Spears, & Branscombe, 2003). Research suggests that ethnic and racial discrimination is a prevalent problem faced by many international students on

United States’ college and university campuses (Rankin & Reason, 2005).

Using quantitative methodology, Poyrazli and Lopez (2007) examined the relationships between homesickness, discrimination, age, English proficiency, and years of residence in the United States. The sample had 439 college students, 198 international and 241 United States students. Among the international students, 19% were European,

65% were Asian or Pacific Islander, 4% were Middle Eastern, 3% were African, 5% were

Latino, and 4% belonged to another racial or ethnic group. Participants completed the

Homesickness Questionnaire that measured level of homesickness and a demographics questionnaire that collected participants’ age, gender, ethnicity, grade point average

(GPA), and the length of time they had lived in the United States. Participants also indicated their perceived discrimination on a 4-point Likert-type scale. Results indicated that international students experienced higher levels of discrimination than United States

16 students, and being an international student from other regions of the world predicted higher levels of perceived discrimination than being a European international student.

More results indicated that the longer international students stayed in the United States, the more discrimination they perceived and older students experienced more perceived discrimination than younger international students.

In another study, Hanassab (2006) assessed the experiences of 640 international students (327 Asians, 158 Europeans, 62 North Americans, 39 Southeast Asians, 27

Middle Easterners, 7 Oceanians, 6 Africans, and 14 Canadians) using questionnaires.

Chi-square analyses indicated that international students from the regions of the Middle

East and Africa experienced more discrimination than do students from other world regions, and that international students experience more discrimination off campus compared to on campus.

Using a case study methodology, J. J. Lee and Rice (2007) explored the experiences of 24 international students (6 Indians, 6 East Asians, 4 Latin Americans, 3

Europeans, 1 African, 1 from the Gulf Region, 1 from the Caribbean, 1 from Canada, and

1 from New Zealand) enrolled in a United States university. The researchers used surveys and interviews to gather information about the process of choosing to study in the

United States, initial perceptions of the United States and the institution, how these perceptions have changed since enrolling in the institution, and specific instances in which participants perceived unfairness or discrimination. Results revealed that students from Asia, India, Latin America, and the Middle East experienced considerable

17 discrimination whereas students from Europe, Canada, and New Zealand did not report any direct negative experiences related to their race or culture.

Some participants understood negative remarks about others’ home country or culture, hostility towards non-fluency in English, and discrimination towards internationals in the United States as direct evidence of cultural intolerance.

Discrimination was specifically reported in the following areas: campus social interactions, interactions with faculty and administration, funding, job opportunities, and off-campus interactions such as housing and shopping.

Constantine, Anderson, et al. (2005) used qualitative research methods to examine the cultural adjustment experiences of 12 Kenyan, Nigerian, and Ghanaian international college students studying in the United States. Data were gathered through semi-structured interviews. Participants reported a range of cultural adjustment problems including discriminatory treatment such as being called names and racial slurs by White

Americans, being viewed as less intelligent than Americans, and being prejudiced by

Black Americans and international students from other continents. This discrimination was reported to contribute to some participants’ loneliness and feelings of isolation.

In yet another study, Houshmand, Spanierman, and Tafarodi (2014) conducted a qualitative study that explored 12 East and South Asian international students’ experiences with racial micro-aggressions. Data were collected through unstructured, individual interviews. Results indicated six racial micro-aggressions themes: (a) excluded and avoided, (b) ridiculed for accent, (c) rendered invisible, (d) disregarded

18 international values and needs, (e) ascription of intelligence, and (f) environmental micro-aggressions (structural barriers on campus).

Because most international students have grown up in contexts in which their racial or cultural group represents the majority, experiencing racial discrimination may be very inconceivable and stressful. Moreover, exposure to racial discrimination may increase these students’ risk for developing or exacerbating mental health problems or concerns. The reviewed literature suggests that discrimination experienced or perceived by international students can be harmful to their identities and personal adjustment.

Homesickness and loneliness. While many university students who live away from home experience some level of homesickness (Chow & Healey, 2008), international students’ transition to a foreign culture can be traumatic, owing to the abrupt shift inherent in the transition (Lowe & Cook, 2003). Homesickness has been defined as a condition characterized by a longing and desire for missing attributes, often resulting in depressive symptoms (Onabule & Boes, 2013). Other researchers have defined homesickness as the distress or impairment caused by an actual or anticipated separation from home (Stroebe et al., 2002; Thurber & Walton, 2012) and sufferers typically report depressive and anxious symptoms, withdrawn behavior, and difficulty focusing on topics unrelated to home (Tochkov, Levine, & Sanaka, 2010). Other effects of homesickness include loneliness, sadness, and adjustment difficulties for students entering the university environment (Constantine, Anderson, et al., 2005). Furthermore, homesickness can exacerbate preexisting mood and anxiety disorders, precipitate new

19 mental and physical health problems, and sometimes lead to withdrawal from school

(Thurber & Walton, 2012).

Homesickness among international students studying in the United States has been studied for many years. For example, Stroebe and colleagues (2002) used quantitative methods to investigate homesickness among 762 European international students. The Utrecht Homesickness Scale (UHS) was used to assess the extent of participants’ homesickness. Depression, personality factors (self-liking, competence, self-esteem), and family situation (attachment to family) were the variables investigated in relationship to homesickness. Structural equation models showed that homesickness was a prevalent experience among participants. Results indicated a positive correlation between homesickness and depression. Results also indicated that students who missed family and friends had difficulties adjusting to college life. These difficulties were associated with ruminations about home and loneliness.

In a comparative study between American and international students, Tochkov et al. (2010) investigated adjustment experiences of 75 students (53% Indians and 47%

Americans from the United States). Participants completed the Homesickness

Questionnaire (HQ) that measured the extent of homesickness experienced by the students, the Beck Anxiety Inventory (BAI) that measured the severity of anxiety symptoms, and the Beck Depression Inventory II (BDI-II) that measured various symptoms of depression. Results suggested that international students experienced significantly higher levels of homesickness than American students; younger students were more likely to experience psychological distress which led to feelings of

20 homesickness; and feelings of anxiety and depression were positively correlated with homesickness.

Similarly, Poyrazli and Lopez (2007) examined group differences in perceived discrimination and the relationships between homesickness, discrimination, age, English proficiency, and years of residence in the United States using a sample of 439 college students (198 international and 241 U.S. students). Participants completed the

Homesickness Questionnaire that measured level of homesickness and a demographics questionnaire that collected participants’ age, gender, ethnicity, GPA, and the length of time they had lived in the United States. Participants also indicated their perceived discrimination on a 4-point Likert-type scale. Results suggested that younger students, students with lower levels of English proficiency, and students with higher levels of perceived discrimination had higher levels of homesickness. In addition, Poyrazli and

Lopez found that homesickness was positively correlated with higher levels of mental disturbance and levels of discrimination by American students.

Even though research has indicated that they are a resilient group, homesickness and loneliness are still pervasive among international students (Johanson, 2010).

Homesickness seems to result in adverse psychological health and poor adaption to new college or university environments (Tochkov et al., 2010).

Conflicting cultural values. When international students come to the United

States, they “carry” facets of their home culture (values, beliefs, concepts, and behaviors learned since childhood) into their new environment. They are also expected to understand and adapt to distinguishable values of their host culture. It is important to

21 note that the ease with which adaption to a new culture occurs depends on a person’s capability of making accurate attributions about the cultural values, beliefs, behaviors, and norms of the new society (Berry, 2008). Berry added that most international students often have cultural values that conflict with the United States’ cultural values and many of them seem torn between maintaining their home culture and identity and adapting to the host culture. If not addressed appropriately, these conflicting cultural values can threaten the academic and interpersonal success of international students (Poyrazli &

Lopez, 2007; Young, Sercombe, Sachdev, Naeb, & Schartner, 2013), resulting in emotional and psychological disturbances such as homesickness, anxiety, stress, depression, and low self-esteem (Berry, 2008; Gu, 2011; Sovic, 2008). Many of the adaptation problems appear to occur when they do not have references to validate aspects of the host culture (Sovic, 2008), when international students want to strictly maintain their individual cultural values and resist change, or when they are unaware of the United

States’ system of rewards and punishment connected to verbal and nonverbal behaviors

(Berry, 2008).

It is important to note that there is no single type of national behavior, no one life style, no one culture in the United States because the country is inherently a nation of immigrants, with innumerable individual differences, ethnic customs, and regional traditions (Denslow, Tinkham, & Willer, 2004). However, individualism, egalitarianism, and open/direct communication styles appear to be practiced by the majority of people in the United States (Green, Deschamps, & Paez, 2005; Hofstede & McCrae, 2004). These values seem to conflict with many of the international students’ cultural values (Gu,

2011; Hofstede, 2011; Zemba, Young, & Morris, 2006) and are often associated with some of their adjustment problems as they study in the United States (Ivey &

Brooks-Harris, 2005; Sue & Sue, 2008). Investigative studies on United States and non- western cultural values are scarce and so conceptual studies were reviewed.

Individualism. Individualism refers to a social perspective that reflects cultural patterns that promote independence (personal freedom) and emphasize the rights, needs, and interests of the individual (Hofstede & McCrae, 2004). It is generally used to describe the predominant cultures of Western Europe, North America, Australia, and

New Zealand (Green et al., 2005). The United States, in particular, was built on the social-political ideals of individualism (Hofstede, Hofstede, & Minkov, 2010). From an early age, children in the United States are socialized to develop a sense of autonomy, and as adults, they are expected to be responsible for themselves and their immediate nuclear families (Hofstede, 2011). The right and freedom to choose one’s own way of life, to live according to one’s own ideas of success, and to personally accept consequences of one’s choices are among the characteristics of individualism (Oyserman

& Lee, 2008).

In addition, accomplishments or successes are attributed to hard work, perseverance, and innate abilities of the individual and social status rewards are given to people who stand out (Oyserman & Lee, 2008). The major calamity is dependence on others (Zemba et al., 2006). In addition, individuals are important for who they are and not from which group they come (Hartung, Fouad, Leong, & Hardin, 2010); and they have certain rights that should not be infringed upon by other individuals, group, or

23 government (Desai, 2007). Furthermore, individualism emphasizes personal control over life situations (Brewer & Chen, 2007) and views life problems as personal inadequacies or unwillingness to take initiative and responsibility (Hartung et al., 2010). Individualism appears to conflict with the collectivistic perspective shared by the majority of international students particularly from Africa, East Asia, the Middle-East, and Latin

America (Abdeljalil, 2004).

Collectivism is a social perspective in which individuals are less invested in themselves but more in the interests, needs, and preferences of the group to which they belong (Hofstede, 2011; Komarraju & Cokley, 2008). It is best described in an African proverb, “I am because we are, and therefore we are because I am” (Carson 2009, p. 327) and it is also reflected in constructs such as “familism” (Hartnett & Parrado, 2012, p.

637) among Latin American families, and “filial piety” (Ho, Xie, Liang, & Zeng, 2012) among Asian families. Among the Middle Eastern cultures, family relationships, loyalty to family, caring for relatives, and gaining approval from one’s family and community dominate an individual’s whole life, and more often than not, individuals rely on family connections for social status, security, influence, and power (Wu, Garza, & Guzman,

2015). It is therefore common to find multigenerational family structures and fictive kinship (consideration of people who are not related by blood as family) among non-western nations (Green et al., 2005). In addition, conformity, cooperation, collaboration, interdependence, and group cohesion are emphasized in collectivistic societies (Hofstede & McCrae, 2004; Wu et al., 2015). This means differences in opinion are reconciled, and individual rights, needs, and desires are suppressed in order to foster a

24 spirit of cohesiveness and to elevate the welfare of the group. For collectivists, the major calamity is ostracism (Zemba et al., 2006).

Furthermore, collectivistic societies tend to believe in their inability to control life situations and attribute life problems to fate, supernatural forces, or other factors beyond individuals’ control (Green et al., 2005). External attributes such as social relations, context, norms, and group pressure are also among determinants of behavior (Wu et al.,

2015). It appears that individualism and collectivism are conflicting social perspectives which many international students may find difficult to consolidate, potentially resulting in behavior restraint and psychological maladjustment.

Egalitarianism. Egalitarianism is defined as a social philosophy that advocates decentralization of power, in favor of equality (The American Heritage Dictionary, 2009) and it is one of the core cultural values of the United States (Samovar, Porter, &

McDaniel, 2010). Although there are many differences in social, economic, political, religious, civil, and educational levels in the United States, egalitarianism seems to be valued in social relationships. Social differences are often not recognized in social interactions and there is not much deference shown to older people, experts, or individuals of higher social status (Samovar et al., 2010; Zemba et al., 2006). In United

States’ classrooms, it is not unusual for some United States’ professors and students to view each other as social equals and for professors to prefer being addressed by their first names (Delb, 2012). In some courses, mainly graduate seminars, professors have managerial roles and the students take the leading role by doing the actual teaching through discussions and presentations (Smithee, Greenblatt, & Eland, 2004). In other

25 courses, students are expected and encouraged to freely challenge professors’ ideas and to consider their professors as facilitators rather than experts (Thomas & May, 2010).

In contrast, many international students come from societies that value hierarchical social structures in which experts, elders, and other authority figures have more power and influence over the novice, the young, and the subordinates (Delb, 2012).

Within such societies, people are expected to understand and act according to their social ranks and prescribed roles, obey existing social order, and not take initiative (Diefenbach

& Sillince, 2012). Therefore, in educational settings, international students may be submissive as they assume that professors would fulfill their expected hierarchical roles of imparting expert knowledge to students who, in turn, are expected to fulfill their role of absorbing the knowledge. They may expect professors to use directive approaches in teaching because the educational systems they are familiar with are teacher- rather than student-centered (Smithee et al., 2004). They may also expect clear boundaries between professors and students and may insist on addressing their professors by titles rather than by first names (Sue & Sue, 2008).

In addition, many international students come from societies whose classrooms are much more formal: students rise when the professors enter the room, students are expected to maintain a respectful silence in the classroom, and stricter standards of behavior are followed (Bista, 2011). In some cases, students are often rewarded for being passive rather than active learners (Abdeljalil, 2004). Therefore, for many international students, asking questions, asking for clarification or elaboration, and engaging in discussions with professors in classrooms may be difficult because they may believe that

26 questioning authority figures and experts is impolite (Norenzayan, Choi, & Nisbett,

2002). Besides, non-western cultures “emphasize accord, harmony, and cooperation . . . and students from these cultures may not possess the oral argumentative skills that are often required in U.S. classrooms” (Samovar et al., 2010, p. 347).

Besides the hierarchical social structures, some collectivistic societies in North

Africa, the Middle East, and Western Asia also tend to be patriarchal, and this means males are born elevated in the societal hierarchy; they are viewed as more superior to females; and they have more privileges than females (Abdeljalil, 2004). Leadership status is bestowed on males whereas all females are classified as naturally unsuited to lead males, no matter what talents and expertise they might possess (Machingura, 2006).

Associated with patriarchal power relations is a gender-linked allocation of social roles and behavior expectations: dominance, confidence, strength, competition, and assertiveness are considered masculine, while submission, nurturing, caring, sensitivity, and emotionality are considered feminine (Sholkamy, 2008). This gender inequality tends to result in gender polarized social roles that are taught to children during the early years of life (Mutekwe & Mutekwe, 2012). This means males are socialized and expected to provide basic needs for the family whereas females are socialized and expected to nurture others and perform household chores. Conformity to these gender roles is highly expected. In addition, patriarchal societies tend to be conservative and this is evident in clothing, communication, and general conduct (Manwa, Ndamba, & Jinga,

2013). According to Manwa and her colleagues, conservatism signifies a cultural value of modesty and any deviation from this value is considered undesirable. It should be

27 noted, however, that attitudes about conservatism also reflect generational socialization and geographical locations in which individuals are born and raised; therefore, older people and those raised in rural areas tend to preserve cultural values and norms

(Mutekwe & Mutekwe, 2012).

Similarly, the education systems are developed within a framework of patriarchy: males are dominant; in classrooms, students are expected to sit separately by gender; and female professors are not expected to teach male students (Abdeljalil, 2004). Thus, international students from patriarchal societies may feel uncomfortable, embarrassed, or self-conscious being in mixed gender classes or working with professors of the opposite sex. These challenges are compounded by non-western religious beliefs that intertwine with patriarchy, forbidding any association among unrelated females and males (Azadeh,

2014). Clearly, the hierarchical and patriarchal notions conflict with the egalitarian values that dominate the United States mainstream culture and contribute to adjustment challenges faced by international students. Discomfort with egalitarian relationship styles may manifest in behaviors that may easily be construed as “abnormal,” resistant, or insight lacking among international students.

Open and direct communication. Individualistic societies such as the United

States and collectivistic societies from which many international students come from differ in terms of communication styles (Sovic, 2008). The majority of people in the

United States value direct, clear, and open communication and often use low-context communication which relies largely on verbal communication with simple and factual statements (Weaver, 2013). Looking directly at someone when conversing and

28 maintaining eye contact is valued, and considered a sign of respect and an indication that one is listening carefully (Carney, Hall, & Smith LeBeau, 2005). Thus, looking away or failing to maintain eye contact is considered a sign of disrespect for the person talking or a lack of interest in what is being said. Most Americans who live in the United States also tend to parallel direct communication with trustworthiness and being honest is usually considered more important than preserving harmony in interpersonal relationships (Weaver, 2013).

In addition, the United States mainstream population places greater emphasis on emotions and emotional expression when they communicate (Carney et al., 2005). Even in a highly public and professional context, speakers take the direct approach and are not afraid to appear shaken by tragedies or disasters (Weaver, 2013). Silence, on the other hand, is associated with awkwardness, misunderstanding, tension, shyness, or disagreement, all generally considered negative qualities by most Americans who, in response, will fill every space in a conversation with words (Meyer, 2009).

Unlike the open and direct communication styles used in the United States, much of the communication styles presented by many international students are indirect, spiral, and relationship-oriented (Sovic, 2008). Many international students use high-context communication, which relies less on the verbal communication and more on additional shared understanding, nonverbal techniques, metaphors, and paralanguage to convey the full meaning of the message. The focus is more on the context than the content of communication. Sometimes, for international students, words play only a minor role while silent communication is the essence of conversations and may carry deep feelings

(Harumi, 2010; Hofstede, 2001). Within the Middle Eastern, Asian, and African societies social image and harmony is prioritized over open and direct communication

(Harumi, 2010). This means that students from these societies may consider it impolite to disagree with someone or to refuse a request and so they may express insincere sentiments in order to avoid conflict. This behavior may not be regarded as an attempt to deceive, but rather appropriate to preserve relationships. As part of face-saving strategies, international students from collectivistic cultures are likely to avoid hurting the listeners’ feelings which could be manifested in the classroom as being indirect, quiet, or evasive during class discussions or group work (Harumi, 2010).

From the reviewed literature, it seems apparent that many international students experience difficulties as they adjust to life in the United States, including English language and academic problems, discrimination, homesickness, loneliness, and cultural values that tend to contrast those of the United States. Despite these difficulties, international students’ utilization of counseling services remains low (H. Chen & Lewis,

2011). Literature suggests that unfamiliarity with counseling services (A. W. Chen et al.,

2009), and societal stigma (Kilinc & Granello, 2003) as the prominent reasons for the underutilization. These reasons may influence international students’ perceptions of mental health counseling.

International students’ perception of professional mental health counseling.

Investigations of international students’ perceptions of mental health counseling have been conducted but they are very scarce, with varied results. For example, Xie (2008) used semi-structured interviews to examine perceptions and attitudes toward seeking

30 counseling of 20 Chinese international graduate students at a United States Midwestern public university. Results on perceptions indicated that Chinese students were generally aware of the concept of counseling, but varied in their knowledge about the counseling process and services. Six participants perceived counseling as a way for people to talk things out and release stress, tension, or pressure. Six participants reported an image of counseling as a client lying on a couch or in a relaxed state talking with a counselor who asks questions to find the root cause of the client’s problem. Some participants reported gaining most of the images about counseling primarily from the media (e.g., movies and television shows), whereas others reported knowing counseling from taking psychology courses or hearing about it from friends who majored in psychology. The majority of the participants (13) perceived the counseling process as similar to medical or consultation model, where patients present problems and counselors listen, ask questions, and give advice or solutions. Fifteen participants reported that their perceptions of counseling had not changed much since they came to the United States and they reported that they did not need counseling. They also perceived that it is normal to seek counseling in the

United States but not in China and that Americans value counseling more than Chinese.

In another study, McRaith (2009) examined the perceptions held about counseling by 71 Asian Indian international students on the University of Wisconsin using a

20-question online survey. Results indicated that respondents were not familiar with counseling and questioned its usefulness to their specific needs. Respondents also reported low expectations of the likelihood of finding a culturally sensitive counselor who had the required self-awareness, knowledge, and understanding of what it is like to

31 be an Asian Indian international student. So, they reported relying heavily on friends and family for mental distress such as stress, addiction, homesickness, anxiety, and depression. Some of the data suggested there might be differences in perception based on gender and location of home state in India. Specifically, females and respondents from the urban areas reported more positive perceptions of counseling than males and respondents from the rural areas.

Similarly, H. Chen and Lewis (2011) interviewed six international students from

East Asia to determine their perceptions of counseling. Results indicated that prior to arrival in the United States, participants had negative notions of therapy. Participants reported that these notions were generated from and reinforced by their culture and family of origin and included viewing counseling seeking as a sign of weakness and as an excuse for escaping responsibilities. A few participants reported being not quite sure about what counseling could do and expressed mistrust of the profession. However, more than half of the participants described their perceptions as changed after they came to the United States and they reported knowing the functions of counseling as: (a) understanding how, what, and why they are troubled; (b) solving problems; (c) dealing with depression; (d) providing guidance; (e) talking things over; (f) digging deeper; and

(g) talking about feelings. Despite this change in perception, all participants reported their unwillingness to seek counseling services and if they did, they would prefer counselors from their ethnic background whom they perceived as more empathic and understanding.

Han, Han, Luo, Jacobs, and Jean-Baptiste (2013) investigated the perception of mental health issues and counseling services by surveying 130 Chinese students at Yale

University. Twenty-seven percent of respondents had never heard of this service before,

92% were open to the idea of using counseling services and wished counseling services were provided in Chinese, 8% stated that they would not or were not likely to use counseling services, even though 45% had depression symptoms and 29% had anxiety symptoms.

Furthermore, using a mixed-methods survey design, Peiwei et al. (2013) explored willingness to seek counseling among 177 Asian international students from a United

States Midwestern university. The qualitative portion of the survey used one open-ended question: “What comes into your mind when you think about ‘counseling’ or ‘mental health counseling’?” Results revealed six themes: (a) counseling is for those with serious mental problems, (b) counseling is helpful, (c) counseling is for solving problems, (d) counseling process mainly involves sharing personal information with a stranger, (e) counseling is for when no one else can help, and (f) counseling is not necessary.

It is clear that the reviewed literature has mixed results. Many international students reported having little or no knowledge of mental health counseling before and after coming to the United States. Some of them reported negative whereas others reported positive perceptions of mental health counseling. Some international students reported being open to counseling whereas others reported being reluctant to seek counseling services. Even though these studies provide insight into international students’ perceptions of mental health counseling in the United States, results should not

33 be generalized to all international students. To avoid such generalizations, studies on specific cultural groups need to be conducted. My study is going to explore Zimbabwean international students’ perceptions of United States mental health counseling.

Although Zimbabwean international students share certain characteristics with other international students, there are some differences relating to Zimbabwe’s historical background, cultural explanations of the causes of mental health problems, mental health care, and healing methods. Awareness of these contextual factors may assist with understanding the meaning of adjustment experiences of Zimbabwe international students and their perceptions of professional mental health counseling. The next section, therefore, provides an overview of Zimbabwe.

Zimbabwe: An Overview

Zimbabwe is a land-locked southern African country with a total area of 150,873 square miles or 390,759 square kilometers (Encyclopedia of Nations, 2014). It lies between the Zambezi River to the north and the Limpopo River to the south. Zimbabwe shares borders with five countries: Botswana, Mozambique, Namibia, South Africa, and

Zambia. Most of the country is a high to middle veld plateau with extensive areas of wooded savanna and a temperate climate. With a population is nearly 13 million, about

70% of the population lives in rural areas, whereas urban areas account for approximately

30% (Encyclopedia Britannica, 2014). Zimbabwe has a centralized government and it is divided into 10 provinces. Zimbabwe’s capital city, Harare, is located in Mashonaland province. The next sections highlight Zimbabwean demographics, political and

34 economic history, education system, cultural explanations of causes of mental health problems, and mental health care and healing methods.

Demographics

The largest ethnic group is collectively known as the Shona and it consists of the

Manyika, Zezuru, Karanga, Korekore, Rozvi, and Ndau groups. The Shona make up about 76% of the population and most of them reside in Mashonaland province, a collective term for the eastern and northern parts of the country. The second largest ethnic group, the Ndebele, constitutes about 18% (Encyclopedia of Nations, 2014) and most of them live in Matabeleland province, the western and southern parts of the country. Other ethnic groups, constituting the remaining 6% of the population, are the

Tonga and the Kalanga in the Zambezi Valley, the Shangani and the Venda in the

Limpopo valley, and Europeans and Asians in the urban areas (Encyclopedia of Nations,

2014). Eighty percent of Zimbabweans belong to Christian denominations, even though most of them also practice and adhere to traditional and indigenous religious beliefs

(Encyclopedia Britannica, 2014). Shona, Ndebele, and English are the official languages of Zimbabwe.

Political and Economic History

Zimbabwe’s earliest inhabitants are believed to be the San hunters who are also known as the Bushmen (Evans, Grimshaw, Philips, & Swain, 2003). When

Bantu-speaking people migrated from the north at the end of the second century, the San either moved west into present day Botswana or were absorbed into the farming and cattle-herding Bantu group known as the Shona. The Shona moved into the area around

35 the 13th century and by the middle of the 19th century, the descendants of the Zulu, the

Ndebele, invaded Zimbabwe and settled in Matabeleland where they established a powerful warrior kingdom (Owomoyela, 2002).

In 1890, the British colonists invaded Zimbabwe resulting in the establishment of the British territory of Southern Rhodesia, named after Cecil Rhodes of the British South

Africa Company (Owomoyela, 2002). After the establishment of a White legislative council in 1899, White immigration increased, and in 1922 the White minority decided that the country would be self-governing and run by the British South Africa Company

(BSAC) as a commercial enterprise. In 1953, on the British government’s initiative, the

Federation of Rhodesia and Nyasaland, also known as the Central African Federation

(CAF), was formed (McNaughton, 2012). The CAF was a semi-independent amalgamation of the self-governing British colony of Southern Rhodesia and the British protectorates of Northern Rhodesia (now Zambia), and Nyasaland (now Malawi). Under an appointed governor-general, the Central African federal government handled external affairs, defense, currency, intercolonial relations, and federal taxes while each member territory handled its own internal affairs. Despite the economic advantages and potential, the Federation was plagued with political differences among the participating member territories and these differences were compounded by numerous demonstrations against the CAF by the Black African nationalists who wanted a greater share of power than the dominant minority White population was willing to concede. The CAF dissolved in 1963 and Southern Rhodesia assumed the name Rhodesia after choosing to remain a British

36 colony when its two partners voted for political independence from Britain (Chung,

2006).

The British government demanded racial equality and proposed to put in place a plan for majority rule, but the conservative White-minority government declared a

Unilateral Declaration of Independence from Britain in 1965, with Ian Smith as the Prime

Minister. Meanwhile, Black Nationalist movements led by Bishop Abel Muzorewa of the African National Congress; Ndabaningi Sithole and Robert Mugabe of the Zimbabwe

African National Union (ZANU); and Joshua Nkomo of the Zimbabwe African People’s

Union (ZAPU) mobilized young people and launched a revolutionary war (chimurenga) against the White government. Smith’s regime withstood British pressure, economic sanctions, and guerrilla attacks in an effort to uphold White supremacy (Owomoyela,

2002). However, in 1976, Smith’s 11 years of resistance began to collapse due to heightened guerrilla warfare and withdrawal of South African military aid (Chung, 2006).

On March 3, 1978, Smith, Muzorewa, Sithole, and Chief Jeremiah Chirau signed an agreement to transfer power to the Black majority (Chung, 2006). An executive council was formed, with chairmanship rotating but with Smith retaining the title of prime minister. Blacks were named to each cabinet ministry, serving as co-ministers to the

Whites who were already holding these posts. However, many African nations and Black

Nationalist movement leaders immediately denounced the action. In 1980, the White minority finally consented to holding multi-racial elections in which Robert Mugabe won a landslide victory as Prime Minister with Canaan Banana as President.

From 1890 to 1980, Zimbabweans endured hardships caused by oppression, racial discrimination, and segregation under British colonialism (Nyagura, 1991). Even after gaining political independence in 1980, they still continued to suffer the negative effects of neo-colonialism (Tofa, 2012; Zeilig, 2008) and dictatorship by a president who had been holding on to power for the past 37 years (BBC News, 2017; Tofa, 2017). The economic crisis that began in the mid-1990s led to hyperinflation of the Zimbabwean dollar and at its worst, in 2008, the foreign currency exchange rate was US$1 to approximately two trillion Zimbabwean dollars (Mazuru, 2014). In 2009, the

Zimbabwean government decided to demonetize (retiring its almost worthless local currency) in favor of a multicurrency economy, including the United States dollar, South

Africa rand, and Botswana pula (African Economic Development Institute, 2009). To date, Zimbabwe has had no currency of its own; it has to rely on paper currency imported from other countries. This situation has led to deflation, that is, the purchasing power of the three currencies used in Zimbabwe are now higher than they otherwise would have been if Zimbabwe had its own currency. To make matters worse, for the past 20 years,

Zimbabwe’s economy has been crippled by floods and drought (Mavhura, Manyena,

Collins, & Manatsa, 2013) and economic sanctions from the European Union, the United

States, the International Monetary Fund, and the World Bank (Fowale, 2010; Hove,

2012). Furthermore, its health system has been deteriorating for the past 10 years

(Manyena, 2006). More than 20% of its citizens are infected with HIV (Joint United

Nations Programme on HIV/AIDS, 2011). Cholera outbreaks have become more frequent in Zimbabwe since the early 1990s (World Health Organization [WHO], 2008).

Education System

During the British regime, the education system in Zimbabwe was segregated based on race (Kanyongo, 2005; Nyagura, 1991). According to Mapako and Mareva

(2013), four types of primary (elementary) and secondary schools existed: government, trust, mission, and community. Government schools were classified into Group A and B.

Group A schools, located in the inner cities and low-density suburbs, were created for

White students. The government adequately funded these schools and therefore, they had highly trained teachers, exceptional resources, and quality education. In contrast, Group

B schools, located in high-density urban residential areas, were created for Black and

Colored (Biracial) students. Because of the very low funding from the government, these schools had fewer resources, less qualified teachers, and lower quality education than

Group A schools. Unlike government schools, trust (private) schools comprised an elite league of schools that was created for White children and supported by private foundations. The schools had governing boards who employed their own teachers and managed their own assets. Trust schools enjoyed similar educational benefits as Group A schools.

Mission schools were operated by White Christian missionaries who were given land grants by the government to build churches and schools for Black and Colored people. These schools were funded by donations from the missionaries’ home country churches. Just like trust schools, mission schools managed their own assets and employed their own teachers. White immigrant teachers were common in these schools.

Community schools, located in rural areas, were built by Black communities for Black

39 children. They were self-funding and operated by local councils. Due to poverty in the rural areas and poor funding by the government, these schools lacked educational resources and failed to attract trained teachers.

Besides offering a Eurocentric education system, the colonial government limited education and censored knowledge in Group B, mission, and community schools

(Nyagura, 1991). As such, the school curriculum for White children focused on academics while the curriculum for Black and Colored children focused on religious studies, agricultural production, industrial development (building, metalwork, and carpentry), and home economics. The medium of instruction in all subjects was English except indigenous languages that were taught as separate subjects.

Regarding tertiary (higher) education, only one university existed and mostly attended by White students from the Group A and trust schools (Kuster, 1999). The majority of Black and Colored students studied in technical colleges, polytechnic colleges, nursing colleges, teacher-training colleges, and other vocational skills training centers where they earned certificates (Mupinga, Burnett, & Redmann, 2005). A handful of Black and Colored students who earned degrees studied at universities outside

Zimbabwe (Nyagura, 1991).

After gaining political independence, the new Black Zimbabwean government declared free and compulsory primary education as an attempt to address disparities in the education system (Mapako & Mareva, 2013). The government schools’ grouping system was abandoned; more schools were built in high-density residential and rural areas for Black and Colored children. Former Group B, community schools, and any

40 other public school have been receiving government funding and educational resources.

More universities, colleges, and vocational centers have been built to meet the demands of the growing student population. Curricula for most subjects have been revised to reflect a more Afrocentric than Eurocentric focus. However, the use of English language as the medium of instruction has been maintained. Due to the economic hardships facing the country, lack of textbooks make teachers and professors the main source of information, resulting in lecturing and providing notes to students (Matereke, 2012).

Just like the colonial era, the current education system is modeled around the

7-4-2-3 British system (Mupinga et al., 2005). This system consists of seven years of primary school (grades 1–7), six years of secondary school (four years of Ordinary Level

[Forms 1–4] and two years of Advanced Level [Forms 5–6]), and at least, three years of tertiary education. The academic year for primary and secondary schools runs from

January to December, with three-month terms (semesters), broken up by one-month holidays. In contrast, most programs in tertiary education are three years long, with the academic year running from August to June.

Since the colonial era, Zimbabwean has been characterized by a bottleneck system of education, that is, extremely large numbers of students in lower levels and limited opportunities in secondary and tertiary education (Nyagura, 1991). As such, this system is intended to weed out the majority of average learners and provide higher education opportunities for the few talented students. According to Kanyongo (2005), the system is heavily exam-oriented and students take standardized national exams at the end of seventh grade, forms four, form six, and the final year of tertiary education. As a

41 result, teachers and professors tend to teach to the test as they focus on exam preparation

(Matereke, 2012).

Besides their political, economic, and educational challenges, Zimbabweans’ cultural explanations of causes of mental health problems and unique healing methods may contribute to their adjustment experiences and perceptions toward professional mental health counseling in the United States. Moreover, the way mental health conditions are perceived or experienced is based on cultural explanations of the conditions, idioms used to report them, contextual factors that maintain symptoms, and healing methods (Kleinman, Eisenberg, & Good, 2006; Mavhura et al., 2013). As such, it is important to understand that the Zimbabwean cultural traditions, customs, and religious beliefs have a strong foothold and remain an integral part of the everyday lives of many Zimbabweans. The next section, therefore, focuses on the cultural explanations of the causes of mental health problems in Zimbabwe.

Cultural Explanations of the Causes of Mental Health Problems in Zimbabwe

Stemming from their traditional religious beliefs, most Zimbabweans construe any form of mental health condition to be caused by external phenomena. These phenomena include the anger of ancestral spirits (Marwizi, 2010), curses (a malevolent appeal to a supernatural being for harm to come to somebody) manifested through witchcraft (Mawere, 2010; Pitorak, Duffy, & Sharer, 2012; Zimbabwe Daily News,

2010), or demons (Basure & Taru, 2014; Gondwe, 2008). Rarely do the mainstream

Zimbabweans attribute mental health conditions to intra-psychic or biological factors

(Kleinman et al., 2006), and this implies that individuals who struggle with mental health

42 conditions are blameless and have no control over life situations. This etiological understanding of mental health conditions is, therefore, likely to influence Zimbabwean international students’ perceptions about Western professional mental health counseling because Western understanding often holds such individuals accountable.

Belief in the Power of Ancestral Spirits

Most Zimbabweans believe in an omnipotent God whom they call Mwari (in God our lives belong), Musikavanhu (God the creator of humanity), or Samasimba or uMlimu

(God Almighty) and he is regarded as the sustainer of the universe (Chavhunduka, 2002;

Mpofu, 2003). Mwari is impersonal and inaccessible to individuals (Sorsdahl, Flisher,

Wilson, & Stein, 2010) and therefore, ancestral spirits (Mhondoro or clan spirits and

Vadzimu/Amadlozi or family spirits) act as intermediaries between individuals and Mwari on all matters concerning everyday life. Interaction with God and the ancestral spirits is made possible through performing rituals and ceremonies (Gunda, 2007; Machinga,

2011). Mhondoro and Vadzimu have distinct roles and responsibilities (Hugo, Boshof,

Traut, Zungu-Dirwayi, & Stein, 2003; Sorsdahl et al., 2010). Mhondoro are usually concerned with the affairs of the clan and any matter which affects the well-being of the community as a whole (for example, succession to the chieftainship, rain, drought, or epidemic diseases), and Vadzimu are responsible for the protection of the family lineages. Many Zimbabweans owe all goodness, human dignity, prosperity, comfort, and good health to both Mhondoro and Vadzimu who are honored in ceremonies during celebrations of good harvest and when good fortune comes to the family (Mavhura et al.,

2013).

Although both Mhondoro and Vadzimu help and protect individuals, they can also be easily offended by those who deviate from tradition, seek more than they are entitled to, leave the village to seek work elsewhere without the permission of ancestral spirits, or move away from one’s birthplace (village) resulting in lineage breakage (Madanhire,

2013). They can also be offended by those who refuse to accept an ancestral calling to become traditional healers (Sorsdahl et al., 2010). Offending ancestral spirits is punishable by poverty, physical sickness, psychological disorders, and other forms of human suffering (Murambidzi, 2013). Both Mhondoro and Vadzimu communicate to the living through svikiro (medium or diviner; Kleinman et al., 2006). Svikiro exhibits a wide range of behaviors such as involuntary movements that resemble epileptic convulsions (Gwimbi, 2009); mutism, incomprehensible language, and change of voice

(Murambidzi, 2013); “holding conversations” with the ancestors and communicating ancestral messages to the living (Madanhire, 2013). Even though these behaviors are similar to some symptoms of mental illness, they are normal if exhibited within the context of cultural rituals (Gwimbi, 2009).

Belief in the Power of Witchcraft

In Zimbabwe, witchcraft (huroyi) is one of the common interpretations given for many unusual and unexplained mental health problems (Machinga, 2011). Huroyi refers to a practice that involves the secretive use of muti (harmful medicines); juju or charms

(gourds containing scales of snake skin, tubers of cactus, knots of river reeds, dead lizards, dry blood, or sheep’s offal); chitsinga (spell); the deployment of tokoloshi (genies or goblins); and any other supernatural devices to cause negative consequences such as

44 psychological harm, illness, misfortune, or death (Mawere, 2011). It is generally believed that witchcraft is not learned; its power emanates from evil spirits that possess the witch and endow her or him with the power to harm and the witch (muroyi) may not be aware of her or his evil powers (Machinga, 2011). The malevolent power of witches

(varoyi) manifest through “animal agents” such as dogs, cats, hyenas, owls, or snakes; and their power can be activated merely by invocating a supernatural power to inflict harm upon someone (Encyclopedia Britannica, 2014). Such an invocation or curse does not have to be voiced; sometimes all a witch has to do is “ill-wishing” someone by making a gesture such as spitting, pointing a finger, or delivering a stare (Mawere, 2011).

Whatever the basis of their power and the means by which it is exercised, witches are credited with causing misfortune as well as physical, emotional, and mental health problems among many Zimbabweans.

Belief in the Power of Demons

Zimbabwean Christians who belong to the Apostolic and Pentecostal churches such as Zimbabwe Assemblies of God-Africa (ZAOGA), Apostolic Faith Mission in

Zimbabwe (AFM), United Family International Ministries (UFIM), Heartfelt

International Ministries (HIM), Spirit Embassy, Prophetic Healing and Deliverance

(PHD) Ministries, and Harvest House International (HHI) regard mental health problems as the work of the devil that uses demons or evil spirits to possess or influence people

(Basure & Taru, 2014; Gondwe, 2008). Gondwe provided a clear distinction between demonic possession and influence. Demonic possession occurs when unclean spirits or fallen angels occupy and own people who lose control of their lives to the spirits residing

45 inside them, but demonic influence is interference from an external position where the evil spirits influence people’s thoughts and behaviors. Demonic forces were categorized by Basure and Taru as animal spirits, spirits of departed relatives, and spirits associated with witchcraft and they cause ailments, distress, misfortune, infertility, and death.

Apostolic and Pentecostal churches also believe that sin has the potential to invite demons into one’s body, and in most instances, sin is viewed as both a cause and outcome of the work of devil (Machinga, 2011). Furthermore, these churches believe that African traditional religious rites and rituals encourage people to worship ancestors instead of God and provide opportunities for demons to possess people (Chavhunduka,

2002; Kileyesus, 2006).

Clearly, there are diverse cultural explanations attributed to mental health problems in Zimbabwe. Consequently, Zimbabweans utilize diverse and distinct methods of resolving mental health problems, some of which are discussed in the next section.

Mental Health Care and Healing Methods in Zimbabwe

Zimbabwe has a multi-layered mental health care and healing system: family caregiving, modern or formal mental health care, traditional healing, and Christian faith-healing (Mpofu, 2003). There is no formal referral system between the four mental health care systems in Zimbabwe (Machinga, 2011). However, it is very common for some Zimbabweans to use more than one method or switch from one method to another during the treatment process (Chavhunduka, 2002). For example, those who may have initially chosen traditional healing methods may switch to modern, Christian faith, or

46 family care if they believe that traditional methods are failing to reduce symptoms, if suspicions about the cause of illness is not confirmed by the traditional healer, if patients and their families are unable to accept the traditional healer’s diagnosis, or if patients and their families are not sure of the prognosis and choose to utilize more than one method.

Similarly, if the mental health condition is believed to be physiologically based, the patients are referred to the modern mental health care.

Family Caregiving

Due to the stigma that surrounds the concept of mental illness in Zimbabwe, members of society who struggle with mental health conditions are often viewed as

“social outcasts” (Mudzingwa & Chazireni, 2015). As a result, it is common practice among Zimbabwean families to hide those who have mental health problems and to seek help from family members and friends. Not much literature is available on family caregiving practices and therefore, the information used in this section was obtained from

Sekuru Mazvimbakupa, a well-respected elder from a village in Zimbabwe.

Sekuru Mazvimbakupa (personal communication, June 30, 2014) emphasized the private nature of Zimbabwean families regarding family issues and the need to keep mental health challenges a secret (“Chakafukidza dzimba matenga”). He provided several reasons why many people in his village prefer family caregiving over other methods: (a) personal problems should not be disclosed to non-family members; (b) understanding, sympathy, compassion, comfort, love, and acceptance are provided unconditionally; (c) privacy, confidentiality, and safety are guaranteed; (d) feedback regarding evaluation of the problem is honestly given; (e) emotional support is readily

47 available whenever needed (day or night), without time restriction, and at no cost; (f) there is little or no embarrassment or shame regarding sharing of experiences, resulting in increased self-disclosure; and (g) there is increased tolerance of disordered mood and disordered behaviors presented by the affected family member. However, if symptoms persist or get worse, families and friends can persuade individuals with mental health conditions to seek help from medical doctors, traditional healers, or prophets

(Mazvimbakupa, personal communication, June 30, 2014)

Modern Mental Health Care

Modern mental health care is part of the Zimbabwean primary health care system

(Ministry of Health and Child Welfare [Zimbabwe], 2012). It is centralized, focuses on psychiatric and HIV/AIDS patients, and emphasizes patient confinement (AVERT, 2011;

Chibanda et al., 2011; Pitorak, Duffy, & Sharer, 2012). Access to modern mental health is, therefore, almost non-existent for the mainstream Zimbabweans (Integrated Regional

Information Networks [IRIN] Global, 2004; Thornicroft, Rose, & Kassam, 2007). A variety of mental health professionals, such as medical doctors, psychiatrists, psychologists, psychiatric nurses, social workers, and occupational therapists, who are trained in Western methods of diagnosis and treatment, implement mental health services and provide psychosocial support (Murambidzi, 2013). The emphasis is on psychotropic medication and hospitalization with little rehabilitation, counseling, and psycho-education (Mangezi & Chibanda, 2010).

The Zimbabwe government provides mental health care at 9 hospitals, 4 referral mental health institutions, and 11 rehabilitation centers or half-way homes (Ministry of

Health and Child Welfare [Zimbabwe], 2012). Several non-governmental and community-based organizations such as the Zimbabwe National Association for Mental

Health (ZIMNAMH), the Red Cross, World Vision, and CARE are involved in the modern mental health care by providing long-term care and psychosocial support programs (Ministry of Health and Child Welfare [Zimbabwe], 2012). ZIMNAMH is the major non-governmental organization, which works directly with the Ministry of Health and Child Welfare to promote the recognition of the rights of people with mental illness and to work towards better care, treatment, rehabilitation and recovery of people who suffer from mental health problems (ZIMNAMH, 2009).

Traditional Mental Health Care

Traditional healing existed in Zimbabwe before the introduction of modern forms of healing (Chavhunduka, 2002; Mpofu, 2003). It refers to the knowledge and skills

(whether explicable or not) used in diagnosis, prevention, and treatment of mental or social problems in which the healer relies exclusively on observation and practical experience handed down from generation to generation, verbally or in writing (Mpofu,

2006). Traditional healers (also referred to as witchdoctors, herbalists, diviners, n’anga, or sangoma) are spirit mediums who diagnose and treat mental illness based on the social, cultural, and religious backgrounds of their patients (WHO, 2010). Most of them are members of the cultural and religious communities they serve and they are more accessible to the mainstream Zimbabweans than modern mental health professionals

(Mpofu, 2006).

The diagnosis and treatment process often begins with the invocation of ancestral spirits by singing, clapping, drumming, and dancing (Chavhunduka, 2002). While under the influence and instruction of ancestral spirits, many traditional healers diagnose mental conditions by mechanical means using items like divination dice (hakata), a “talking” calabash, mirror, medicated water, or cloth (Chavhunduka, 2002). Other traditional healers diagnose by sniffing the patients, interpreting dreams and omens, or assessing how patients and their families are adhering to cultural beliefs (Machinga, 2011).

Treatment then takes different forms depending on the demands and prescriptions of ancestral spirits to the patients, their families, and the larger community.

Gunda (2007) identified various forms of traditional healing methods that are used to get rid of evil spirits and curses: (a) exorcising using stinking plants (rukata) or salted water; (b) putting the patient in a trance to overcome the evil spirit; (c) giving patients herbal extracts from barks and roots of trees or plants to drink, wash with, or sprinkle around and in the house; (d) extracting objects from the body by biting

(kuruma); (e) rubbing herbs on patients bodies (kukwiza); (f) making body incisions to directly administer herbal treatments into the blood stream (kutema nyora); (g) blowing smoke into the patient’s face (kupfungaidza); (h) suctioning bodily fluids with a medicated horn (kudzura); and (i) placing a patient and a pot of boiling water or a smoking log under a blanket for the patient to inhale the steam or smoke, with the intention of “choking” evil spirits. Simwaka, Peltzer, and Banda (2007) described other healing methods: (a) inducing vomiting (kurutsiswa); (b) spitting medicated water or powdered tobacco (snuff) on the patient’s face; (c) smashing a clay pot at crossroads to

50 cast out bad spirits; (d) transferring bad spirits into animals; and (e) transferring bad spirits into coins and discarding the coins at crossroads (kurasirira). Chavhunduka (2002) identified offering of sacrifices such as cattle, goats, beer, cloth, or blankets as a way of appeasing angry ancestral spirits (kupira).

Traditional healers are registered and licensed by the Zimbabwean government as a way of recognizing their legitimacy, ensuring safe practices, and standardizing culturally-based healing methods (Ministry of Health and Child Welfare [Zimbabwe],

2012). The Zimbabwe National Healers’ Association (ZINATHA) and the Traditional

Medicine Practitioners’ Council (TMPC) are examples of legal associations to which all traditional healers should belong (Ministry of Health and Child Welfare [Zimbabwe],

2012). The majority of Zimbabweans recognize traditional healers as competent providers of mental health care and individuals with mental health challenges tend to first seek assistance from traditional healers prior to accessing the modern health care system

(Muchinako, Mabvurira, & Chinyenze, 2013).

Even though traditional healing is the most widely recognized mental health care used by mainstream Zimbabweans, it is also the most controversial within Zimbabwe and differs significantly from Western professional mental health counseling. Regardless, it is recognized by the World Health Organization, which is making efforts to promote collaborative efforts between the biomedical and indigenous healing communities (WHO,

2010).

Christian-Faith Healing

Apostolic and Pentecostal churches believe that exorcism by prayer or deliverance is the only way that brings about true mental health healing (Machinga, 2011). Exorcism is the act of casting out demons from people who are believed to be possessed by them or people who are liable to become instruments of their malice (Exorcism, 2012). It is performed by prophets whose healing powers are channeled from God (Mohr & Royal,

2012). Most exorcism processes involve rebuking demons, special prayers that are accompanied by prolonged fasting, anointing with blessed oils, chanting, singing and dancing emphatically, bible reading, speaking in tongues, laying of hands on the afflicted, and prophecy (Kenner, 2010). Sometimes prophets invoke the demons to reveal themselves and to engage in dialogue about the motive of the possession, the nature of the spirit, and misfortunes it has brought or will still bring to the possessed individual

(Kileyesus, 2006). Even though they don’t have formal counseling training, prophets also serve as counselors and use different helping skills like encouragement, empathy, caring, humility, acceptance, and unparalleled mercy (Basure & Taru, 2014; Mohr &

Royal, 2012). As such, individuals with mental health problems are required to have faith in the work of the prophets for healing to take place

Chapter Summary

The presence of international students studying in the United States is increasing each year (Institute of International Education, 2013). Mental health professionals, therefore, should be prepared to address complexities that arise with diversity by understanding contextual factors that influence the adjustment experiences of

52 international students as they study abroad. This understanding will help tailor services for international students who struggle with mental health problems.

Research is limited in studies that explore experiences of African international students, particularly Zimbabweans. The reviewed literature, therefore, focused on international students from a variety of countries and suggested lack of proficiency in

English language, discrimination, homesickness/loneliness, and conflicting cultural values as the most prominent and unique adjustment problems experienced by many international students. In spite of these challenges, international students tend to underuse professional mental health services even though counseling services have been found to be helpful.

To date, no studies have explored the adjustment experiences of Zimbabwean international students and their perceptions of United States mental health counseling.

This study, therefore, attempts to fill the gap in the existing literature. It is important to study and understand the unique experiences of Zimbabwean students so that overgeneralizations are avoided. The Zimbabwean historical background (political, economic, and social), and culturally informed causes and forms of mental health care were described to give context to the experiences of Zimbabwean international students studying in the United States.

CHAPTER II

METHODOLOGY

This chapter explains the research design and the methodological approach used in conducting this study. The purpose of this study was to understand the adjustment experiences of Zimbabwean international students and their perception of mental health counseling in the United States. The first section describes the research design used in this study and reviews the various forms of qualitative research as I offer the rationale for selecting basic interpretative qualitative research. Other sections covered in this chapter include the researcher’s role and assumptions, population and sample, data collection methods, data analysis, trustworthiness, and ethical considerations.

Research Design

This study seeks to understand the meaning of adjustment experiences of

Zimbabwean international students as they study in the United States and their perception of United States mental health counseling. Qualitative inquiry was used to gather and to analyze information because of the explorative nature of the research questions

(Creswell, 2013). Qualitative inquiry refers to “any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification” (Strauss & Corbin, 1990, p. 17). It explores people’s experiences in natural settings where the “phenomena of interest unfolds naturally” (Patton, 2002, p. 39) and the outcome is described within the context in which it is examined (Patton, 2002).

Similarly, Donalek and Soldwisch (2004) described qualitative inquiry as an organized, systematic exploration of some portion of human experience, and it is concerned with the

53 54 discovery of common emergent themes obtained from information provided by research participants. A more comprehensive and richer analysis of the descriptive data obtained from this study is more likely to be provided by a qualitative than a quantitative inquiry.

There are various approaches to qualitative research including basic interpretive, narrative, phenomenology, ethnography, and grounded theory (Creswell, 2013). My study used the basic interpretive theory because it is the most appropriate approach for my research questions, and I give my rationale for dismissing narrative, phenomenology, ethnography, and grounded theory and selecting the basic interpretive approach.

The narrative approach focuses on gathering data through the collection of one or more people’s stories, analyzing them in terms of internal thoughts, motivation, written text, or spoken word (Creswell, 2013). The stories are then reported in chronological order of participants’ individual experiences. The narrative method was not selected because the purpose of my study is not to describe life stories, delve into history, or focus on analyzing content.

Phenomenology “focuses on the essence or structure of an experience . . . showing how complex meanings are built out of simple units of direct experience . . . an attempt to deal with inner experiences unprobed in everyday life” (Merriam, 2002, p. 7).

A phenomenological researcher must be descriptive, engage in reduction, and discover the essence (Giorgi, 2008). Phenomenological research was not selected because my study does not seek to enter participants’ conceptual world to explain the essence of their lived experiences.

Ethnography focuses on interactions, social context, and the social construction of reality by a culture-sharing group. It focuses on an entire cultural group, and serves to interpret and describe shared and learned patterns of behaviors (Creswell, 2013). Thus, it involves cultural interpretation of data. Ethnography is most useful when the researcher is grounded in cultural anthropology and immerses herself or himself in the culture under study (Rubin & Rubin, 2005). This approach is inappropriate for my study because I am not seeking to explain socio-cultural aspects of participants’ experiences.

Grounded theory aims to inductively derive a theory that is grounded in the data

(Artinian, Giske, & Cone, 2009). It involves comparing units of data against other units until categories, properties, and hypotheses that state the relationships between categories and properties emerge (Merriam, 2002). It emphasizes discovery with description and verification as secondary concerns (Creswell, 2013). The grounded theory approach was not selected because the purpose of my study is not to generate a new theory.

Clearly, narrative, phenomenology, ethnography, and grounded theory approaches are unsuitable research methods for my study. Rather, the basic interpretive approach seems the optimal choice for my study because it seeks to gain understanding of the meaning given to social phenomena (Creswell, 2013).

The basic interpretive approach views reality as socially constructed and aims at interpreting “a phenomenon, a process, and worldviews of people involved, or a combination of these” (Merriam, 2009, p. 6). Data are derived from participants’ perspectives as the researcher attempts to “understand the meaning of experiences from participants’ frames of reference” (Imel, Kerka, & Wonacott, 2002, p. 1). This “meaning

56 is mediated through the researcher as the instrument, the strategy is inductive, the outcome is descriptive” (Merriam, 2009, p. 6). The researcher seeks to figure out shared meanings of participants and at the same time, she or he needs to recognize that each participant will interpret the experience in her or his own unique way as determined by previous experiences and socio-cultural factors (Rubin & Rubin, 2005). In my study, I explored, described, and interpreted the meaning of Zimbabwean international students’ adjustment experiences and their perceptions of United States mental health counseling.

Description of Researcher and Assumptions

In qualitative research, “data are mediated through a human instrument, the researcher, rather than through some inanimate inventory, questionnaire, or machines”

(Merriam, 2009, p. 19). For this study, I am the primary instrument for data collection, analysis, and interpretation. This role necessitates the identification of relevant aspects of self, including personal experiences and assumptions, at the outset of the study

(Greenbank, 2003).

I am a female doctoral candidate in the Counselor Education and Supervision program at Kent State University in Kent, Ohio. I was born and raised in Zimbabwe. I am a professional mental health counselor, licensed in the state of Ohio and I have worked in community mental health settings in Indiana and Ohio. I am a member of the

American Counseling Association (ACA), the Ohio Counseling Association (OCA),

Ohio Association of Multicultural Counseling and Development (OAMCD), Eastern

Ohio Counseling Association (EOCA), and Zimbabwe Counseling Association (ZimCA).

ZimCA is a support network comprised of mental health professionals outside of

Zimbabwe. I am also a college lecturer who has been teaching in higher education since

2001. I am married and I have three children.

I have a personal, vested interest in the adjustment experiences of international students and their perceptions of United States mental health counseling. Twenty years ago, I enrolled as an undergraduate international student in a university in the United

States and became a professional mental health counselor a few years later. Even though

I share many adjustment experiences with other international students, I also acknowledge that there are individual variations and differences in the way all international students adjust to life in a foreign country.

I lived in other countries before coming to the United States. This exposure to other cultures may have contributed to the relative ease with which I adjusted to life in the United States in comparison to most international students who have not lived outside of their countries prior to studying in the United States. In addition, I did not have difficulties communicating or learning in English because English is one of the official languages in Zimbabwe and it is the medium of instruction in all schools. I grew up in a

Christian home and never practiced non-Christian indigenous religions common in

Zimbabwe. Furthermore, I came to the United States with my husband and my two older children who were my primary support system. My husband, who also came to the

United States as an international student, was sponsored by an American organization and so I did not experience financial difficulties regarding basic needs. I do not recall experiencing any prejudice or discrimination.

However, there are some experiences that I share with potential participants of this study. I had limited social support and experienced emotional turmoil during the first few years of being in the United States. I was a full-time student who was raising two small children and hardly socialized with other students. In addition, within those first few years of being in the United States, a series of unfortunate events occurred resulting in distress and homesickness. For example, I had two major surgeries but my parents and siblings were not able to visit due to United States visa restrictions. My husband and my older daughter had surgeries a few months apart and I almost quit school due to severe stress and poor concentration in school. My worst experience was when my oldest brother passed away and I couldn’t afford to go home for his funeral. As if this were not enough heartbreak, my father passed away seven months after my brother’s passing. I experienced severe emotional and psychological difficulties but I did not seek counseling services because I had never heard of professional mental health counseling prior to coming to the United States. Besides, I was socialized not to share my struggles with anyone who was not my family.

Meanwhile, the HIV/AIDS epidemic was claiming the lives of some of my immediate and extended family in Zimbabwe. In addition, political unrest and economic hardships prevailed and my mother’s and siblings’ wellbeing was threatened. With this pile-up of stressors, I could not take a break from my studies because of my student visa conditions; I had to soldier on. This very sad series of events prompted my curiosity and interest in pursuing a profession that focused on helping people cope with difficult life

59 situations. Not long after I recovered from my loss and grief, I enrolled in a graduate program in Clinical Mental Health Counseling.

After completing my master’s degree, I worked at a non-profit mental health agency located near a university in Indiana. I noticed that most international students who sought services did not return for services after the initial contact and I wondered why they terminated services prematurely. In addition, my previous and current experiences as a faculty advisor for international student organizations and hostess for international scholars have enabled me to become aware of adjustment and cultural concerns present among international students. Every semester, for the past 15 years, I have held formal and informal conversations with international students who have shared their economic, educational, and social struggles as they study in the United States.

My aforementioned experiences, therefore, have led to my interest in empirical investigation of adjustment experiences of international students and their perception of

United States mental health counseling. I believe that these experiences enhance my awareness, knowledge, and sensitivity to the issues being addressed in this study and will assist with working with international students from Zimbabwe. At the same time, I recognize the need to be open to the perceptions and opinions of participants because my foreknowledge can limit my understanding of their perspectives because I already know a great deal about the phenomena under investigation. Even though I make every effort to ensure objectivity, in part through the strategies discussed in the “Trustworthiness” section, I also acknowledge that my personal values and interests can introduce bias into

60 the research and hinder my ability to research the topic thoroughly (Parahoo, 2006). I, therefore, acknowledge entering this research process with the following assumptions:

1. Participants will have negative adjustment experiences similar to those

experienced by other international students who participated in previous

studies.

2. Participants will have negative perceptions of professional mental health

counseling due to their unique worldviews, including different

conceptualization and treatment of mental health problems.

3. Participants will be aware of professional mental health services, but

underutilize services due to unfamiliarity with services.

4. Participants will answer demographic and interview questions truthfully and

accurately and display genuine actions throughout this research study.

Sample

There are no closely defined rules for sample size in qualitative research

(Creswell, 2013; Patton, 2002) and there is variability in what is suggested as a minimum. Qualitative studies tend to use small samples and focus on in-depth understanding and information richness rather than on representativeness of the population (Guest, Bunce, & Johnson, 2006). Crouch and McKenzie (2006) proposed that a sample of less than 20 participants helps a researcher build and maintain a close relationship with participants, resulting in improved open and frank exchange of information. Moreover, small sample size studies generally involve more contact time with each interviewee in terms of longer and/or repeated interviews (Mason, 2010).

Some methodologists have suggested that sample size be determined by demonstration of saturation (Latham, 2013; Mason, 2010). Saturation refers to a situation where the data collection process no longer offers any new or relevant insights

(Marshall, Cardon, Poddar, & Fontenot, 2013). Based on their review of recommendations of qualitative methodologists, Guest et al. (2006), for example, found that saturation occurred around 12 participants in homogeneous groups. Similarly, based on review of literature about justifying sample size of qualitative interviews,

Onwuegbuzie and Leech (2007) concluded that most of the data saturation had occurred with 12 interviewees. Other qualitative research methodologists have presented general guidelines and ranges for sample size. Patton (2002) suggested that single digit numbers, if selected purposefully, can generate meaningful and insightful in-depth data. Morse

(2000) suggested 6–10 participants and Creswell (2011) suggested 10 or fewer participants as adequate sample sizes.

For practical purposes, I used a sample size of 9 participants due to the relatively small numbers of Zimbabwean international students studying in the United States and also due to data saturation. To be eligible, participants had to be at least 18 years old and currently studying in the United States. Participants had to have been in the United States for at least one year and the United States had to be the only foreign country in which they have been a college or university student. To ensure protection of participants, I sought approval to conduct my study from the Kent State University Institutional Review

Board (IRB). Once the approval was obtained (see Appendix A), I began the recruitment process using the snowball sampling method.

Snowball sampling involves accessing informants through contact information provided by other informants. This process is, by necessity, repetitive as informants refer the researcher to other informants, who are contacted by the researcher and they, in turn, refer the researcher to yet other potential informants (Noy, 2008). The process continues until sufficient potential participants have been identified to meet the desired sample size

(Noy, 2008). Snowball sampling is appropriate for situations in which the individuals sought do not form a naturally bound group but are scattered throughout populations

(McMillan & Schumacher, 2001). I had an advantage of identifying and recruiting potential participants because I am from Zimbabwe and I had contact with Zimbabwean students at The University of Akron, Cleveland State University, and Mercer University.

I sent out a recruitment email with screening questions (see Appendix B) to these

Zimbabwean students to find out if they were willing to participate, forward my e-mail to other Zimbabwean students, or put me in contact with other Zimbabwean students they knew who are studying in the United States. When I got names and contact information of new potential participants, I emailed the same recruitment email to them. This snowball recruitment continued until I had a sufficient number of potential participants who met the inclusion criteria and I was beginning to get similar information and no new insights. The recruitment procedure is presented in Figure 1.

Prior to data collection, an informed consent letter explaining the purpose of the study, data collection methods, risks, benefits, confidentiality assurance, and participants’ rights (voluntary participation and withdrawing from study when they choose to) was e-mailed to participants’ preferred e-mailing addresses (see Appendix C). I also included

63 a separate audio recording consent form requesting potential participants to give permission to record interviews and to use recordings for research and educational purposes (see Appendix D). I asked potential participants who committed to participation to sign and return both consent forms. Upon receipt, consent forms were kept in a locked cabinet in my office, 404 White Hall, Kent State University, Kent Ohio,

44240.

Valerie Rose Dillon

Elite Simba Nate

Trevor Stacy Tay

Figure 1. Recruitment procedure

Data Collection

Data were collected from nine Zimbabwean international students who were studying at six United States colleges and universities. A demographic questionnaire and

64 two semi-structured interviews were used to collect the data. Some interviews were conducted in person and others were conducted via telephone.

Demographic Questionnaire

During the initial part of the first interview, I asked participants to complete the

Demographic Questionnaire. The pseudonyms Dillon, Elite, Valerie, Nate, Rose, Simba,

Stacy, Trevor, and Tay were used to protect participants’ identities. Participants provided information about their age, sex, partner status, children status, primary language, level of education they are pursuing, length of stay in the United States, and religious affiliation

(see Appendix E). I reviewed demographic responses with each participant in order to build rapport; their responses are presented in Tables 1 and 2. Participants’ ages ranged from 24 years to 54 years. Three participants were female and six were male. Dillon,

Elite, Simba, Stacy, Trevor, and Tay indicated they were married, their partners were in the United States, and they had children who were also in the United States. Valerie and

Nate indicated they were single and they had no children whereas Rose indicated that she was divorced and had two children. All participants indicated their primary language was

Shona and they were all Christians. Stacy was the only undergraduate student whereas the rest of the participants were graduate students. The length of stay in the United States ranged from two years to nine years. After the demographic information was reviewed, I began conducting and recording the first interview.

Interviews

Interviews were used to explore participants’ adjustment experiences in United

States’ colleges and universities, and their perception of United States mental health

65 counseling. Interviews are appropriate in investigations where depth of meaning is important and the research is primarily focusing on gaining insight and understanding

(Ritchie & Lewis, 2003). Interviews are also appropriate in investigations where the significance of context is recognized (Patton, 2008).

Table 1

Participant’s Demographic Information (1)

Is Partner in the If you have children, are Participant Age Sex Partner status United States? they in the United States?

Dillon 54 Male Married Yes Yes

Elite 37 Male Married Yes Yes

Valerie 24 Female Single N/A N/A

Nate 27 Male Single N/A N/A

Rose 49 Female Divorced N/A N/A

Simba 40 Male Married Yes Yes

Stacy 53 Female Married Yes Yes

Trevor 30 Male Married Yes Yes

Tay 35 Male Married Yes Yes

Interviews were conducted either in person or via telephone depending on how far the participant was in relation to where I live. The face-to-face interviews were conducted in a private research carrel at Kent State University library with Dillon and in my private office at Kent State University with Elite. The rest of the interviews with

Valerie, Nate, Rose, Simba, Stacy, Trevor, and Tay were conducted via telephone. All the telephone interviews were conducted from my private office and participants were

66 asked to be in a location that is private and free from distractions. All interviews were conducted on days and times convenient for participants.

Table 2

Participant’s Demographic Information (2)

Primary Length of stay in the Participant Language Level of Education United States Religion

Dillon Shona Graduate 4 Christian

Elite Shona Graduate 2 Christian

Valerie Shona Graduate 6 Christian

Nate Shona Graduate 6 Christian

Rose Shona Graduate 9 Christian

Simba Shona Graduate 8 Christian

Stacy Shona Undergraduate 7 Christian

Trevor Shona Graduate 4 Christian

Tay Shona Graduate 5 Christian

A Word document, with the order in which participants were interviewed, date and time of interview, interview location and interview method (telephone or face-to-face), and dates about all other data collection and analysis activities, was created.

Specifically, semi-structured interviews were conducted with each participant, individually. Interviews lasted about 45 to 90 minutes and involved open-ended questions. Open-ended questions were appropriate for this study because they helped reduce researcher bias and consequently allowed participants to be constructors of their knowledge and to become conveyors of thoughts that can be interpreted by the interviewer (Anderson & Taylor, 2009). They also provided opportunities to prompt and

67 probe deeper into participants’ experiences and perceptions thereby generating rich data

(Patton, 2002).

Interview questions used in this study were developed based on the reviewed literature and emerged as a result of a gap in the literature. The two main questions and two sub-questions were used during the first interview:

1. What are your adjustment experiences while studying in the United States?

(a) How do you resolve or cope with problems you encounter while

studying in the United States?

2. What are your perceptions of the United States mental health counseling?

(a) What experiences have helped shape your perceptions of United States

mental health counseling? (see Appendix F).

When needed, follow-up questions were used to gain more understanding and clarity.

Since semi-structured interviews are non-standardized, the order, phrasing, and follow-up questions were tailored to each participant and flexibility was significant to allow for unforeseen ideas and insights to be thoroughly investigated (Patton, 2005).

From the inception of the investigation, I developed a timeline of data collection and analysis in order to keep track of all activities related to the study (see Tables 3 & 4).

Interviews were audio recorded and labeled according to pseudonyms assigned to each participant prior to data collection. After each interview, I wrote reflective process notes about my feelings, thoughts, reactions, hunches, and initial interpretations. Reflective process notes are important because they act as a preliminary form of data analysis and keep in check my assumptions and biases (Merriam, 2009). Audio recordings were

68 stored in password protected electronic files before, during, and after transcription. Staff in the College of Education Health and Human Services Research and Evaluation Bureau at Kent State University transcribed seven of the nine interviews (Dillon, Elite, Valerie,

Rose, Nate, Trevor, and Tay). I transcribed Simba’s and Stacy’s interviews. I read the transcripts more than once and listened to the audio recordings in order to make sure that interviews were correctly transcribed. Transcriptions were stored in password protected electronic files and those in print were stored in a locked cabinet (404 White Hall, Kent

State University, Kent, Ohio). Within 3–8 weeks of the initial interview, transcriptions and initial interpretations were emailed to participants for review (see “Member checking”).

The second interviews were conducted approximately 2–4 weeks after the participants had received the initial transcripts and initial interpretations. These interviews lasted about 30 minutes and they were also conducted either face-to-face or via telephone. The interview questions allowed me to gain more understanding of the first interview and provide participants opportunities to clarify content, corroborate themes, and share new information (see Appendix G). Participants also got an opportunity to share additional information which may been stimulated by the playing back process (Burck, 2005).

Second interviews were audio recorded and because they were much shorter than the first interviews, I transcribed all of them. Once transcripts were complete, I listened to the audios again and read them to check for errors and stored them in password

69 protected electronic files. Again, both audio recordings and printed transcripts were stored in a locked cabinet (404 White Hall, Kent State University, Kent, Ohio).

Table 3

Data Collection and Analysis Process (1)

Month Activities

May, 2016  IRB approval  Participation invitation emails to Dillon, Valerie, Elite, Nate, and Rose  Consultation with dissertation co-directors about data collection process

June, 2016  Consent forms sent and received from Dillon, Valerie, Elite, Nate, and Rose  Individual face-to-face interviews with Dillon and Elite  Phone interview with Valerie

July, 2016  Participation invitation emails to Simba, Stacy, Trevor, and Tay  Consent forms received from Simba, Stacy, Trevor, and Tay  Phone interviews with Nate, Rose, Simba, Stacy, and Trevor  Interviews transcriptions (for Dillon, Valerie and Nate) completed by staff in the College of Education Research and Evaluation Bureau at Kent State University  I transcribed Stacy’s interview

August, 2016  Phone interview with Trevor  Interviews transcriptions completed (Elite and Rose) by staff in the College of Education Research and Evaluation Bureau at Kent State University.  I transcribed Simba’s interview  Phone interview with Tay  Listening to interview audios to verify transcripts (Dillon, Valerie, Elite, Nate, and Rose)  Consultation with NVivo expert (who works at the Kent state University Library) to discuss coding process  Data coding (Dillon, Valerie, Elite, Nate, and Rose)  Consultation with dissertation co-directors to discuss coding process

September,  Interview transcriptions completed (Trevor and Tay) by staff in the College of 2016 Education Research and Evaluation Bureau at Kent State University  Data coding (Rose, Simba and Stacy)  Identifying emerging themes  Consultation with NVivo expert to discuss categorization process  Transcripts and initial interpretations were e-mailed to Dillon, Valerie, Elite, Nate, Simba, and Stacy

Table 4

Data Collection and Analysis Process (2)

Month Activities

October, 2016  Listening to interview audios to verify transcripts (Trevor and Tay)  Data coding (Trevor and Tay)  Transcripts and initial interpretations were e-mailed to Rose, Trevor, and Tay  Second interviews (by phone) with Dillon, Valerie, Elite, and Nate  Consultation with NVivo expert (who works at the Kent State University Library) to discuss code collapsing  Code collapsing and identification of emerging themes

November, 2016  Second interviews (by phone) with Rose, Simba, and Stacy  Transcription and coding of 2nd interview (Dillon, Valerie, and Rose)  Consultation with NVivo expert (who works at the Kent State University Library) to discuss categorization process  Consultation with dissertation co-directors to discuss codes, categories, and emerging themes

December, 2016  Second interview with Trevor and Tay  Consultation with Kent State University faculty (who has expertise in qualitative research) to review categories  Consultation with dissertation co-director to review categories  Categorization of all codes  Exploration of themes

January, 2017  Consultation with peer reviewer to review a sample of transcripts and codes  Code revision

February, 2017  Consultation with peer reviewer to discuss codes, categories, and themes  Consultation with dissertation co-directors to review themes  Refinement of themes

Data Analysis

Qualitative data analysis is a “process of bringing order, structure and meaning to the mass of collected data” (Bazeley, 2007, p. 181). In this study, this process involved gleaning and highlighting key segments of the data that relate to participants’ adjustment experiences and their perception of United States mental health counseling. NVivo, a

Qualitative Data Analysis (QDA) computer software (Hilal & Alabri, 2013), was utilized to manage the data.

Coding

After the transcribed data were imported into NVivo, I had three separate meetings with two Kent State University data analysis consultants to discuss efficient strategies of coding participants’ responses. Coding is the process of systematically sorting and grouping information from interviews, allowing researchers to create a similarity-based organization of descriptive data (Maxwell, 2005; Miles & Huberman,

2012; Saldana, 2013). Charmaz (2014) advised that a detailed line-by-line coding be done to reduce “the likelihood of imputing your motives, fears, or unresolved personal issues to your respondents and to your collected data” (p. 94). However, Stern (2007) argued that there is so much filler that can be skipped over and suggested to look for the

“cream of the data” (p. 118). Thus, for each participant, I identified and tagged only the meaningful segments of the data that were relevant to participants’ adjustment experiences and perceptions of professional mental health counseling. The codes I used were not predetermined but they were derived from data as suggested by Saldana. The codes were in the form of words and short phrases, for example, “education,” “social support,” “language barrier,” “transportation,” “food,” “language,” and “unfamiliar with counseling.” I wrote down definitions of the codes in my process notes and assigned the same code to all the segments that exemplified the same descriptive idea (see Table 5).

My codes were not rigid because qualitative data analysis tends to be an iterative process as data are continuously explored, reflected on, queried, and re-coded (Hilal & Alabri,

Table 5

Sample of Interview Excerpts, Codes, and Meaning

Interview Excerpt Code Meaning

“I found out that uh, in the classrooms, it was Education classroom atmosphere; teaching more- kind of a freer atmosphere than the uh, approaches; classroom behavior I don’t want, don’t want to call it the rigid expectations; communication with atmosphere I was used to, where the professors; use of instructional instructor did the talking and I only spoke technology; class schedule; and when the instructor asked me to.” assignments

“Sometimes, I would occasionally also social support any help from church members, family realize that uh, it was helpful to sit down members, friends, other students (both with my wife at some point and just kind of domestic and international), graduate bounce off ideas and figure out some things assistants; spouse that you know, we would try to solve together. So there was- the wife was there. There were also social friends but uh, up to a certain extent; the same applied with the church which also was really, really helpful. Yeah, church organizations, the churches we went to. Because they provided a lot of support with- some of it was material and at times, some of the help was financial. So it [the help] was spiritual, financial, you know, and uh, material.”

“Um, well, it, it, it started off as um, uh, very language English language barriers: speaking, difficult um, in terms, in terms of um, you barrier understanding; reading, writing, accent, know, the language barriers or probably like, cultural reference, different terminology the accent, the understanding of different accents. So I-, when I came here, I was in the south, started off in the south, and um, it was kind of hard to hear what my professors were saying. Uh, it was hard to hear um, the people you know. So, it was kind of hard in terms of actually learning in class. It took a while to adjust and it kind of affected my grades in terms of- I couldn’t really understand, you know.

2013; Rubin & Rubin, 2005). Every time I coded, I compared the codes with previous codes to ensure that my coding was consistent and allowed the possibility of the creation of new codes for segments that did not fit into existing codes (Gibbs, 2007). My peer

73 reviewer also assisted with checking for consistency between the relevant data units, codes, and their definitions after she read samples of transcripts. She provided very helpful feedback that I used either to rename or collapse some codes. When new codes were developed, I applied them to the whole data set. I re-read data until all key ideas were identified and coded. As I continued with the coding process, I kept notes of my thoughts and ideas about the coding process and noted emerging connections (themes) between the codes. I kept a list of all the codes and I reapplied them when related data were encountered in the second interview.

Literature does not give a set number of codes to be used or developed per data set. However, Creswell (2013) suggested starting with 5–6 provisional codes;

MacQueen, McLellan-Lemal, Bartholow, and Milstein (2009) suggested 30–40 codes; and Lichtman (2013) suggested 80–100 codes. After my initial cycle of the coding process, I had 64 codes and this number was within the range suggested in literature.

However, after the second interview and consultation with both my peer reviewer and my dissertation committee about the coding process, I found that larger segments of texts were better suited to capture one key code rather than several smaller ones, and so I collapsed the original 64 codes into 23. When codes were saturated (that is, when the data no longer provided any new or relevant codes) and all relevant data were accounted for, I categorized the coded data.

Categorization

Gibbs (2007) defined categorization as a process of assembling similar codes based on the similarities of meaning between the individually coded segments of the data,

74 and Saldana (2013) defined categorization as synthesizing the collective, not to arrive at a reduced answer but to move toward consolidated meaning. I explored and identified categories based on relationship and the underlying meaning across codes. In order to guide the categorization process and to capture the essence of participants’ experiences, I continually asked myself the following question as suggested by Saldana (2013): Are these codes making reference to a similar concept or experience? I had a total of 12 categories and I recorded my thoughts and significance of the categories in a memo.

Examples of categories I identified include “basic needs,” “language,” “education,”

“support system,” “personal initiatives,” and “cultural practices.” I shared these categories with my peer reviewer, a Kent State University faculty (with qualitative research expertise), and my dissertation committee who shared their insights and suggestions, which I took into consideration during the process of refining the categories and identifying initial themes.

Theme Exploration

Rossman and Rallis (2012) defined a theme as “a phrase or sentence describing a subtle and tacit process” (p. 282) whereas Saldana (2013) defined it as an outcome of coding, categorization, and analytic reflection. As such, themes from my study began to emerge during the interviewing, and coding activities. I explored more themes during the categorization and reflection processes and a total of 10 themes were generated. Initial themes were shared and discussed with my peer reviewer who indicated that most of my themes were on target and that I captured the main points of the transcripts. She provided very helpful suggestions; for example,

I also wondered about whether an overarching theme of a “Perceived cultural

barrier to counseling” or “counselor cultural competency”—maybe these are two

different things now that I think about it. I’m not sure. “Perceived cultural

barrier” may be that the international student traditionally uses family members

and elders for help in resolving problems and “counselor cultural competency”

may be purely on the counselor. The counselor doesn’t understand specific

cultural beliefs and customs. I don’t know. I thought of this when I was reading

the transcripts and thought I’d share. (P. Minor, personal communication,

January 18, 2017)

Feedback from my peer reviewer was taken into consideration during further theme exploration. After revising my themes, I again consulted my peer reviewer and my dissertation committee who provided more insights that were also considered in the final theme refinement. For example, my peer reviewer shared the following:

General Living Problems—I don’t know if this theme captures the sub-themes.

Doesn’t offer much in terms of description. I think what may be throwing it off is

the weather because it doesn’t seem to fit in with basic needs (other than getting

appropriate clothing). I was wondering about an overarching theme like

Acclimating to Various Environments or something like that (combining the

weather with your academic expectations theme). They’re adjusting to the

university and to weather conditions, i.e., watching the weather report which they

didn’t have to do before—think about how they have to dress for the weather. (P.

Minor, personal communication, January 28, 2017)

The initial interpretations (themes) of data were shared with participants for their review (member checking) and their feedback guided the second interview. During this second interview, I asked the following questions to ensure accurate understanding of the first interview: (a) Are the transcripts and my initial interpretation congruent with your adjustment experiences and perceptions of professional mental health counseling? (b)

Have any of your adjustment experiences and perceptions of professional mental health counseling been omitted? (c) What other additional adjustment experiences and perceptions would you like to share? (d) Share your thoughts and comments on the interpretation of the data (see Appendix G). The second interview, therefore, allowed participants to illuminate and verify interview responses, share any new information, and corroborate the initial interpretations of the data. All relevant new information from the second interview was coded and categorized in the same way as the initial interview responses. Further theme exploration was conducted until no new themes were generated. Five overarching themes emerged and they seemed to clearly describe participants’ adjustment experiences and their perception of United States mental health counseling.

During and following data collection and analysis, data were kept electronically in password-protected files and in print. Printed information was securely stored in a locked cabinet in 404 White Hall, Kent State University, Kent, Ohio. Audio recordings and transcripts will be destroyed when my study is complete.

Trustworthiness

According to Patton (2002), trustworthiness denotes “traditional scientific research criteria” (p. 544) and it includes “objectivity of the inquirer (attempts to minimize bias), validity of the data, systematic rigor of fieldwork procedures, triangulation (consistency of findings across methods and data sources), reliability of coding and pattern analyses, correspondence of findings to reality” (Patton, 2002, p. 544).

These methods of rigor refer to the confidence that can be placed in both the data and the analysis to ensure that research is plausible, credible, consistent, and accurate (Lincoln &

Guba, 2000). I took the following steps to ensure trustworthiness of this study: member checking, memos, reflexivity, and peer reviews.

Member Checking

To ensure credibility and accuracy, all the dialogues of the interviews were transcribed verbatim and transcriptions were mailed to and verified by the participants, a process known as member checking (Lincoln & Guba, 2000) or participant validation

(Bogdan & Biklen, 2007). Creswell (2009) also stressed that member checking is best done with “polished” (p. 191) interpreted pieces such as themes and patterns emerging from the data. As such, within 2–8 weeks of the initial interview, I provided and asked participants to review both their own transcribed information and my initial interpretations to ensure that both are congruent with their adjustment experiences and perceptions of United States mental health counseling (see Appendix H). Feedback from this review was the primary focus of the second interview, which was conducted 1–2 weeks after participants received transcripts and interpretations. All participants agreed

78 that transcripts were accurate and three participants shared additional information. For example, Rose added,

Everything looks pretty good. The only other thing I might need specified is that

culturally, we do not seek professional mental help. We rely on family and

friends. I may have heard about counseling services here [in the United States],

but I thought I would just tough it out.

Similarly, Valerie added,

Last time when I stated that my experiences were better than other Zim students, I

did not mean that I had it easy. I felt lonely—sometimes—and uh, I actually ran

out of money a few times. Thank God I had relatives who came to my rescue.

Not that they just gave me the money. Uh, I mean, they lended me the money and

I had to work hard to give it back.

Member checking results helped me gain clarity and more understanding of the information shared in the first interview. Within 4–8 weeks of the second interview, themes that emerged from both interviews were e-mailed to participants for their review

(member checking).

Memos

The basic interpretative approach, just like other qualitative research approaches, involves a process of simultaneous data collection and analysis (Charmaz, 2014). To aid this process, memos were used as a procedural and analytical strategy throughout the research process. Memos are formally written records of emerging categories and relationships of data and they serve to enhance data exploration (Burck, 2005). Creation

79 and maintenance of memos from the beginning until the end of the study guided the process of research and enhanced data exploration (Patton, 2002). My memos also included critical notes, particularly about participants’ paralanguage and nonverbal behaviors. These notes helped me determine the probable inconsistencies and misunderstandings of the information provided by participants. My memos also included reminders, instructions or critiques, emerging ideas, categories, themes and the relationships between and among these. Memos also encouraged and reminded me that I was, in fact, an instrument for data collection and that the information I was collecting is pertinent (Meyrick, 2006).

Reflexivity

Reflexivity refers to self-awareness and critical self-reflection that act as ethical safeguards related to fairly representing participants’ experiences and perceptions (Burck,

2005). The reflexivity process was guided, in part, by the questions recommended by

Sunstein and Chiseri-Strater (2012): What surprised me? (to track my assumptions).

What intrigued me? (to track my positionality). What disturbed me? (to track tensions within my value, attitude, and beliefs). From the inception to the completion of my investigation, I kept a self-reflective journal of my impressions (for example, “He is very articulate in spoken English; I wonder if he went to a former white school”), thoughts (for example, “I think he did not understand my question and I need to rephrase the question and explore this topic further”), feelings (for example, “I felt so sad when she spoke about her father’s death because I also lost my father”), observations (for example, “She has made several references to her resilience”), assumptions (for example, “He seemed

80 hesitant to give examples; could it be a cultural thing”), and interpretations (for example,

“She has a positive view of counseling”). I, therefore, used the reflective process to capture my observations, choices, and insights; as well as question my assumptions and biases (Patton, 2002). In addition, the reflective process led me to develop conceptual and categorical questions that enhanced my data collection and analysis.

Peer Review

I sought the assistance of a peer who has experience in qualitative research to review transcripts and analyses of the collected data. This peer reviewer was a doctoral candidate in the Counselor Education and Supervision Program at Kent State University and she was not affiliated with my research. She only served “as a mirror, reflecting the researcher’s responses to the research process and will also serve as the devil’s advocates, proposing alternative interpretations to those of the investigator” (Morrow, 2005, p. 254).

The reviewer was not provided with participants’ identifying information; pseudonyms were used as identifiers.

After data were collected and coded, I provided the peer reviewer with samples of transcripts and codes, categories, and themes to check for inconsistencies, over- and underemphasized points, vague descriptions, or biases (see Appendix I). I also asked the peer reviewer to provide feedback and suggestions to ensure that categorization and data analyses were accurate. I used my judgment and made adjustments from the peer reviewer’s feedback.

Ethical Considerations

With regards to ethical considerations, a researcher must anticipate any ethical issues that may arise during the qualitative research process (Creswell, 2011). Creswell, therefore, emphasized that researchers need to protect their research participants by developing trust with them, promoting the integrity of the research, guarding against misconduct and any impropriety that might reflect on their organizations or institutions, and cope with new challenging problems. In my study, I did not anticipate any risks or ethical dilemmas beyond those of daily life because participants will not be required to engage in any unethical or dangerous actions. However, in order to protect participants’ rights, I:

1. Gained approval to conduct this study from the Kent State University Human

Subjects Review Board

2. Disclosed to participants the nature, purpose, risks, and benefits of my study,

3. Informed participants that I will refer them to local mental health counseling

centers to receive services, in case they become distressed during or after the

interviews,

4. Informed participants about the voluntary nature of their participation and that

they can withdraw from the study at any time without penalty,

5. Advised participants to feel free to decline answering any questions, at any

time, during the interview process,

6. Informed participants about data collection methods and member checking

process,

7. Made interpretations of the data available to the participants,

8. Assured confidentiality by keeping consent forms and interview data in locked

cabinets and password protected electronic files, and destroying audio

recordings and transcripts when the study is completed, and

9. Kept a self-reflective journal of my experiences and reactions, and use them to

question and understand my own assumptions and biases.

Chapter Summary

This chapter discussed the research design that was employed in this qualitative study and the rationale for using basic interpretive research methodology. Sample selection process, assumptions, data gathering, and data analysis procedures employed in this study were discussed. This chapter also included the methods I used to ensure trustworthiness of my study, a description of researcher’s role, and ethical considerations applied in this research. The next chapter presents the findings of the current study.

CHAPTER III

RESULTS

The purpose of this study was to understand the adjustment experiences of

Zimbabwean international students as they study in the United States and to explore their perception of United States mental health counseling. The basic interpretive qualitative approach was utilized to gather and analyze the data. The following research questions guided the study:

1. What are the adjustment experiences of Zimbabwean international students as

they study in the United States?

2. What are the Zimbabwean international students’ perceptions of United States

mental health counseling?

Semi-structured interviews were conducted with nine participants who were recruited using the snowball sampling method. After interviews were transcribed, NVivo, a

Qualitative Data Analysis (QDA) computer software, was used to code and categorize responses. Codes were developed inductively from the data and categories were derived by collapsing codes based on meaning and relevance to the research questions. Themes were then identified based on commonalities of participants’ experiences as they adjusted to life in the United States and on commonalities of their perceptions of United States mental health counseling. This chapter presents in-depth results of the data analysis, including participants’ demographic information.

83 84

Participants’ Demographics

Participants were recruited from six universities in the United States. They provided information about their age, sex, partner status, children status, primary language, level of education they are pursuing, length of stay in the United States, and religious affiliation. To protect participants’ identities, pseudonyms were used. Tables 1 and 2 provide a breakdown of the demographic characteristics. Participants’ ages ranged from 24 years to 54 years. Three participants were female and six participants were male. Six participants indicated they were married, their partners were in the United

States, and they had children who were also in the United States. Two participants indicated they were single and they had no children. One participant indicated she was a divorcee. All participants indicated their primary language was Shona and their religion was Christianity. There was only one undergraduate student whereas the rest of the participants were graduate students. The length of stay in the United States ranged from two to nine years and so they came to the United States between 2005 and 2014.

Core Themes

Five overarching themes, that provided an understanding of the “big picture”

(Braun & Clarke, 2006, p. 102), emerged from the data analysis: (a) limited resources, (b) navigating the United States’ academic environment, (c) socio-cultural barriers, (d) limited exposure to United States mental health counseling, and (e) self-reliance and informal supports leading to acclimation. These themes seemed to capture participants’ adjustment experiences and their perception of United States mental health counseling.

The next section provides detailed descriptions of the five themes. Excerpts from interviews are provided as illustrations.

The first theme, limited resources, represents participants’ struggles with meeting basic needs such as finances, housing, food, transportation, and support system. The second theme, navigating the United States’ academic environment, represents participants’ challenges with teaching approaches, academic expectations, classroom behaviors, technology, and relationship with professors. The third theme, socio-cultural barriers, captures issues relating to language and cultural practices. The fourth theme, limited exposure to United States mental health counseling, relates to participants’ limited experiences with and unfamiliarity with professional counseling. The last theme, self-reliance and informal supports leading to acclimation, relates to coping strategies used by participants while studying in the United States.

Theme 1: Limited Resources

The first theme, limited resources, represents participants’ struggles with meeting basic needs. All nine participants reported one or more of the following struggles: limited finances, difficulty securing housing and food, transportation issues, and limited support system. These struggles were mostly experienced during the first few months upon arrival in the United States.

Finances. Interview data suggested that participants were not well informed about the cost of living in the United States. As a result, they were financially ill-prepared upon arrival in the United States. Some participants realized that they were underfunded by their sponsors whereas others realized that the money they had saved for

86 use in the United States was not adequate for both college tuition and basic needs. In addition, employment restrictions by the United States government seemed to have compounded participants’ financial hardships. Depending on the type of visa participants held, some were allowed to work part-time only on their campuses whereas others were not allowed to work at all. All participants discussed at length how lack of finances seemed to be one of the major problems in adjusting to life in the United States. For example, Stacy had difficulty paying for her education and she stated:

I had to postpone my studies at some point because of the very high tuition. Both

my husband and I were college students at the time. It’s not like back home

where you just go to school, as long as you have $500. Here, they talk of

thousands of dollars. And when you are married to a student who is just getting a

stipend, you know how much that is? Maybe a thousand dollars. Even saving out

of pocket to get tuition for two people was tough.

Rose discussed at length her financial hardships. She reported being sponsored by a Zimbabwean private company but this was a partial scholarship. She reported self-funding everything that was not covered by the scholarship. When the economic crisis occurred in Zimbabwe, her sponsor defaulted on payments. She expected to receive some financial assistance from her university in the form of a scholarship or assistantship because she was an outstanding student but she did not. She also expected to get a financial donation from her employer because she was almost at the end of her studies but she did not. In addition, Rose expressed frustration associated with lack of information about the United States employment guidelines for foreigners:

I quickly realized that when you are a foreign student, you’re not allowed to work

without a work permit. I had no idea that I could not work. Had I known before

coming here, I would have applied for the permit. To make ends meet, I ended up

getting an under the table job. It’s a risk that I was willing to take because I

realized I had to, somehow, make things work for myself.

Simba shared similar financial struggles that made him question if his struggles were worthwhile. At the same time, it seemed as though his struggles motivated him to work hard in school. He stated:

Life was and is still expensive but I had a choice. I could quit school and go back

to Zimbabwe or persist and complete my studies. But when I came here,

Zimbabwe was experiencing the worst economic crisis and I knew going back to

Zimbabwe was not even an option. Ironically, lack of money helped me to work

even harder in school to accomplish the goals that I had set out to do. That’s also

the reason why I finished my undergrad studies in the shortest possible time.

Spending more time in school meant more financial struggles.

Elite expressed financial concerns associated with providing for his immediate family who joined him in the United States six months after his arrival. His spouse did not work because she did not have a work permit. His children had to be in school and needed school supplies. He stated that he could have sought financial help from his parents and siblings in Zimbabwe, but it was very expensive to send money to the United

States due to hyperinflation of the Zimbabwean currency during the time he moved to the

United States.

Housing. In addition to lack of finances, eight of the nine participants struggled with securing housing, including efforts of trying to secure housing before arrival in the

United States. For example, Elite acknowledged that his university contacted him before he came to the United States and provided websites for various housing options.

However, he could not secure housing while in Zimbabwe because he faced challenges related to payment of the security deposit and the rent. Even when he arrived in the

United States, Elite found it difficult to find accommodations. He explained:

They all wanted me to pay with a credit card, which I didn’t have. We don’t use

credit cards in Zimbabwe. We use debit cards. So, when I arrived in the United

States, I had no place to live. Luckily, the housing office on campus gave me

accommodation just for overnight, in a hostel. I requested accommodation for 7

days but my request was denied. Anyway, the manager of the housing office gave

me phone numbers to different local hotels where I ended up staying and paying

$84 per night for five days. It was a difficult experience. I finally got in touch

with some Zimbabwean colleagues who then helped me look for alternative,

cheaper accommodation.

Similarly, Simba had nowhere to stay when he arrived in the United States. He reported staying in an expensive motel during his first few days of being in the United

States until he got an apartment that he rented with another student. He stated that even though he knew some Zimbabweans who owned houses in the area, they did not offer him a place to stay. Likewise, Trevor reported difficulties securing housing. He did not

89 know that leasing houses involved checking his credit score and criminal background, and signing a contract. He explained:

In Zimbabwe, you rent a flat [an apartment] or a room in somebody’s house and

you don’t fill out and sign any papers. People trust people. Here, it was different.

I did not have a credit score and they could not check my criminal background.

Many places did not want me to lease their flats. I finally signed one and I have

never left the place up to now. It’s now 5 years and I’m still staying in the same

flat. I don’t want to go through the same hardship again.

Food. In addition to difficulties associated with housing, most of the participants had food issues upon arrival in the United States. The food was either unfamiliar, names used for food were foreign, or participants did not know where to get familiar food. For example, Trevor reported:

I had problems with where to find groceries. When you finally find a grocery

store, the food is different. Names were different and sometimes, labels were in

languages other than English and so I would just go blank. When you go to a

restaurant, the server would ask you what you want. That was worse because you

don’t know what to order. You don’t even know what the food is made of.

Similarly, Elite expressed his concern about eating pizza and uncooked vegetables, food he considered foreign. He reported missing the familiar foods like cooked leafy green vegetables, peanut sauce, and heavy starch meals like sadza

(Zimbabwe’s staple food). After dining in a Mexican and then an Asian restaurant, Elite found that Mexican, Asian, and Zimbabwean cuisine were similar. He then was able to

90 obtain most of his groceries from Mexican and Asian food markets. He found it difficult to adjust to American food, especially seafood and some fast foods.

Transportation. In addition, all of the participants experienced transportation issues because they did not own cars. They reported having to rely on public transportation that was not always reliable. For example, Nate expressed frustration with the high cost and inefficiency of taxis; “It took the taxi about 2 hours to pick me up and I was always late to most of my first classes.”

Similarly, during his early days of being in the United States, Tay had problems associated with not knowing the correct buses to take when traveling between his apartment and his university:

The main and easy mode of transport here is when one has his own car. Using

buses was hard. The buses had numbers, 1–26, and you had to find out for

yourself the exact bus to take you to your particular destination. So for me, this

was not easy to figure out.

Dillon reported going to his campus, shops, and church, for miles, on foot. He reported walking, most nights, to and from his campus because bus services were not available at night. He had this to add:

I was given a map at the new student orientation session but I had no idea about

the geographic layout of the place. The map was almost useless. I got lost so

many times. Besides, I used to walk long distances in the dark, in an area that I

later realized was not safe at all. Sometimes, it was raining and other times, it

was very hot. I had no choice but to continue walking until I finally bought a

used car during the second semester.

Support system. Eight of the nine participants reported lack of support system resulting in feelings of loneliness and isolation. They came to the United States alone, had difficulty contacting their families due to time zone differences and high calling costs, and had difficulty making friends. For example, Elite had this to say about his experiences:

The only people I interacted with were my professors, classmates and staff. And

this was when I was on campus. After class, I was all by myself. My wife and

kids stayed home [in Zimbabwe] when I came here. They joined me almost 6

months later. But I had a few names of Zimbabweans who were in other states

but I did not have their contact information. I can still remember Thanksgiving of

2014 when campus was literally empty and I spent the holiday indoors, alone.

Everyone had gone to gather with family and friends. You get to a point where

you can’t even tell whether you want to go back home or stay on.

Likewise, Rose elaborated on how life was difficult because she was alone and felt abandoned. She reported getting out of a very difficult marriage just before coming to the United States. She left her children in Zimbabwe and she indicated that adjusting to life in a different country, under such circumstances, was very difficult. She had this to add:

I remember whenever people were asking about my family, I would just break

down and cry. I felt lonely. I hardly spoke to anyone except classmates during

class. I had no close person to share my situation and off-load my issues. That is

how difficult life was. You feel abandoned; you feel alone; you feel like this is

going to lead to mental health issues. I can see why many people would break

down under such circumstances. There were so many times when I cried and

people didn’t even know what was going on.

Equally, Simba had difficulties reconnecting with former Zimbabwean acquaintances who were already in the United States. He reported that his former acquaintances had assimilated to the United States’ culture and they did not want to associate with him.

Some people, when they come here, it’s like, over night, they change. So, they

don’t want to be associated with their culture and with you. So, you feel so alone.

I felt very isolated. I didn’t bring my family with me. They joined me after one

year. It’s like you go to school, come back, and you are in your room alone. So,

loneliness was a major problem. I’ve seen quite a good number of students who

come over here and then they start developing problems, even mental problems,

and they end up going back home.

Even though Valerie had relatives in the United States and former high school classmates in the United States and Canada, she reported being isolated because none of these people lived close to where she attended college. She also had difficulty making connections with domestic students. She explained her situation:

Well, the most difficult thing was trying to fit in with the group [classmates].

Being a foreigner is not always easy in a different country, a new country. I had

relatives here (in the United States), but they lived in another state. I also knew a

few people from Zimbabwe but they were isolated as well, scattered across

America and in Canada. Because of school and high cost of traveling, I could not

visit them and neither could they. When I bought a cell phone, then I started

talking to a good friend in Canada.

Theme 2: Navigating the United States’ Academic Environment

Six participants reported having difficulty navigating the United States’ academic environment and three participants found it easy to transition from Zimbabwean to

United States system of education. Topics discussed were: (a) teaching approaches, (b) academic expectations, (c) classroom behaviors, (d) technology, and (e) relationship with professors.

Teaching approaches. Some participants reported challenges related to the fast-paced learning in classrooms in the United States. They found it difficult and uncomfortable to participate but realized that their classroom behaviors had to change in order for them to be academically successful. Other participants reported challenges regarding the prominence of class discussions in classrooms in the United States in contrast to the prominence of lectures in Zimbabwean classrooms. For example, Tay reported relying on his Zimbabwean teachers and professors for all educational content.

He reported struggling with exam preparations because his professors rarely provided notes; students were expected to take notes from class discussions. He was concerned about his grades because he was not sure whether or not he had the correct notes to study for his exams. He stated,

Lectures were better. I like lectures. When I was in Zimbabwe, I knew what to

study for exams. Here, you write down your classmates’ discussion points but

you don’t know if the points are facts. You don’t know if you are supposed to

study those points for the exams. Some professors do not even give a summary of

the discussion. So, you just hope that what you write down is correct.

Likewise, Dillon discussed his discomfort with student-led discussions because he was used to having his Zimbabwean professors provide all content. He questioned his professors’ expertise and expressed concern about the quality of his education because

“students had to teach themselves and most of the time, professors did not provide us with content.” Dillon also felt that his professors did not take time to know his academic background and his abilities. He stated,

I will hasten to say that one of the biggest problems is the lack of exposure which

some of the instructors had in terms of our background education. I always felt

that I had to explain myself or show my instructors that I can do or understand

what they were asking me to do. No other student would be asked to explain their

answers. I think it was an assumption that I did not know anything because I was

coming from Africa. But sometimes, I would do my assignments without any

help at all.

Elite talked about his classroom experiences and concerns regarding meeting requirements such as consulting faculty during office hours. He reported feeling pressured to ask questions during class or visit professors during office hours because “it

95 was expected but I felt I did not have genuine questions because I had read and understood the material on my own.” He explained further:

My challenge mostly was that, back home, you don’t just ask a question for the

sake of asking. Even if you are to ask about something that you don’t know, you

need to at least to do some research about it so that you don’t appear like a fool.

Here in the United States, professors expect and encourage students to ask any

question in class and to visit the professors in their offices for guidance. In

Zimbabwe, faculty used office hours to prepare for lectures and to grade

assignments. They did not have official time to meet or interact with students

outside of the classroom. But here in America, students get credit for asking

questions and for visiting the instructor. Unfortunately, I hardly earned such

credit.

Simba talked about challenges related to the fast-paced learning in the United

States. He described class situations in which instructors would pose questions and expect immediate answers from everyone. He felt disadvantaged because English was his third language and yet, he was expected to answer questions quickly before he thought his answers through. He expressed frustration that his instructors did not understand his language challenges. Similarly, Stacy discussed the fast-paced learning related to homework and assessments. She stated that in Zimbabwe, assignments were more spaced-out than in the United States where she had to submit weekly written assignments and take weekly quizzes. She added:

I had to pay more attention in class because professors would say things just once

and move on to the next thing. I had to do a lot of catching up outside class. I

had to pay close attention to deadlines and it was tough because I was taking more

than 12 credit hours per semester. I had to be on task all the time. I had due dates

that came up too quickly when my assignments were not done. I actually had to

sleep late. Most of the time, I would sleep 4–5 hours per night.

Trevor was concerned about the United States-specific humor used by his professors. He understood that the humor was intended to liven discussions, but he felt excluded because he lacked the socio-cultural context associated with the humor. He explained,

One day, my professor said a joke about something which was popular culture in

the United States in the 1990s. I did not get it. I had no idea what they were

talking about. Another professor said a joke about Sarah Palin. Everyone

laughed except me; I did not know her at that time. I was not here [in the United

States] to experience the whole thing surrounding that particular Presidential

election and I failed to get the joke. Some people thought I was dry or I lacked a

sense of humor or I was a Republican or something like that, but it was lack of

cultural context.

In contrast, Valerie did not have trouble adjusting to the United States’ teaching approaches. She acknowledged that differences in teaching methods existed between

Zimbabwe and the United States but the differences did not deter her academic success.

She found the new teaching methods empowering, and she explained:

I quickly found out that the classroom atmosphere was freer than the somewhat

rigid atmosphere I was used to. In Zimbabwe, the lecturers did the talking and I

only spoke when the lecturer asked me to talk. I did not like that because I like

talking and asking questions, that’s why. In Zimbabwe, students just accept what

lecturers say and what they give. You don’t question and you don’t challenge.

Academic expectations. Whereas some participants found academic expectations in the United States rather challenging in comparison to their experience in

Zimbabwean colleges, others did not. The expectations ranged from use of office hours to homework and grades. For example, Stacy discussed discomfort associated with the expectation of visiting her male professors during office hours when she needed further help with understanding course content or when she wanted to discuss her concerns related to her academic performance. She reported that as a female, meeting one-on-one, in a private space, with a male who was not her relative was considered inappropriate, in her culture. She reported preferring to meet with her male professors in public places.

The last few times she utilized office hours, Stacy reported asking a classmate to accompany her to visit her male professors.

Simba discussed challenges related to grade expectations. His American university expected him to earn As and Bs only, “otherwise you would be on academic probation if you earned less than a B. If you earned two Cs, then you would be dismissed from school.” The higher academic expectations required Simba to be “working on research projects or doing homework all night until morning hours. I could not risk failing.” Similarly, Tay reported challenging expectations related to homework. He

98 stated that homework and projects had to be completed every week in the United States whereas in Zimbabwe, he would only complete about three written exams per semester.

He stated, “They [professors] make you busy. Most of the time, you’ll be focused on writing papers. I just couldn’t get time for anything else.”

In contrast, other students did not experience challenges related to academic expectations. For example, Valerie discussed how her boarding school experience in

Zimbabwe helped her with a relatively smooth academic transition.

The German nuns and priests who ran my boarding school were pretty strict.

They set very high standards for us on behavior, grooming, and grades. They had

us on a schedule from the minute we woke up until bedtime. We had ‘quiet time,’

which was strictly study time. This could be two to four hours per day. So, the

structured activities and routine were very good in terms of planting a sense of

discipline in us. So, when I came here, I kind of maintained what was planted in

me years earlier. I am actually doing very well in all my classes.

Even though Rose reported higher academic demands, especially heavy coursework, she was an exceptional student who had already developed resilience when she attended boarding school in Zimbabwe. She knew how to balance her work, school, and family throughout her studies and managed to maintain a very high grade point average.

I was actually pleasantly surprised to see that I was very competitive in an

American college. In fact, I had a GPA of 3.9 at the end of my masters’ program.

In most of the classes, people were surprised that I would always just get a perfect

score even though I was a minority and came from Africa. People did not quite

expect that but they did not know that the education system in Zimbabwe has high

standards too. If I made it over there, I knew I would make it over here. I should

say though, the coursework here was very busy work but not very hard. It’s

funny that I struggled with everything else except school.

Likewise, Trevor found college work not as challenging in the United States as it was in Zimbabwe. He had no trouble meeting academic expectations. He explained:

I found the education system not as rigorous as the system that I went through. I

did my bachelor’s and master’s degrees in Zimbabwe and I came here for my

Ph.D. I found that people tend to get graded based on midterms, homework, take

home finals, and so many extra credit points. The system here has less rigor than

it was back home; things are much easier for me. So, I will say I’m used to

getting easy “As” essentially; it’s much easier here. In Zimbabwe, lecturers

would expect more out of you and exams were tougher.

Classroom behavior. Other participants faced challenges they encountered in the classroom when trying to draw their professors’ attention. Simba gave a very representative example of a time when he raised his hand and snapped his fingers to provide an answer but his professor ignored him. Another student later informed him that his behavior was considered disrespectful in the United States. Simba explained, “I didn’t know that snapping fingers is a gesture used to address pets like dogs. I felt bad and I had to apologize to my professor. But seriously, snapping fingers for attention is very common in Zimbabwean classrooms.” However, later on, when he raised his hand

100 without snapping, the professor would not call his name to answer questions and he reported getting confused.

Instead, the professor would talk to and entertain students who were talking over

his voice and were not even raising their hands. I found that to be strange. In

Zimbabwe, it is impolite to interrupt a professor or to speak before your name is

called. Now I don’t even attempt to raise my hands. No one seems to be willing

to give me a chance to speak.

Valerie was concerned with how American students dressed up for classes. She always tried to have a professional style, whereas her American peers were wearing casual clothes to classes. She added, “You wouldn’t go to class in sports attire, tank tops, or flip flops when we were in Zimbabwe. It was expected that we wear decent clothes, semi-formal to formal.” Valerie also found behaviors in American classrooms such as eating, drinking coffee, chewing gum, side conversations, and openly uttering seemingly rude and disrespectful comments to professors inappropriate and distracting. Dillon and

Nate reported similar concerns.

Technology. Participants reported experiencing stress related to the use of technology especially computers. They were required to type and print assignments.

Sometimes, they were required to submit assignments electronically to their professors.

However, most of them had no computer skills because computers were scarce in

Zimbabwean colleges. Stacy seemed to have the best attribution to these difficulties.

Having to learn with computers was something new for me. Unlike in Zimbabwe

where most assignments were handwritten, in the United States, I have to type all

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my assignments and yet, I had not used a computer before coming to the United

States. In Zimbabwe, students only submitted one typed term project and students

would actually pay professional typists to type their work. During my first days

here in America, I would first handwrite my papers and then slowly but surely

type them up. My classmates would laugh when I told them it took me the whole

day to type up 2 pages. It’s different; people here start using computers from age

3 years.

Like Stacy, Trevor summed up his own struggles:

There are many things I had to learn to be able to complete assignments.

Everything had to be done on the computer, from papers to discussions. I was

also a graduate assistant and I had challenges using printers, photocopy machines,

and fax machines.

Relationship with professors. Participants expressed discomfort regarding the egalitarian relationships between professors and graduate students in the United States.

Tay provided the most representative discussion related to participants’ experiences. He reported having a peer relationship with his professors in which he was treated as a colleague. Some of his professors invited him into their homes for social events. In addition, he stated that his professors focused on helping him uncover and pursue his own interests rather than telling him what to study, as was the case in Zimbabwe. He added,

“Sometimes you get confused and don’t know how to behave because you were so used to be a subordinate and always told what to do and how to do things by lecturers in

Zimbabwe.”

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Theme 3: Socio-Cultural Barriers

All nine students reported experiencing hardships that were associated with socio-cultural differences between United States and Zimbabwe. Most of the discussions were about language and general cultural practices.

Language. Language barriers, in terms of understanding others and being understood, seemed apparent throughout participants’ discussion of their adjustment experiences. Attributes to communication problems cited by participants included terminology differences, differences in meaning of words due to cultural reference, translation issues, and accent differences. All nine participants reported Shona, the main indigenous Zimbabwean language, as their primary language and English, as a second, third, or fourth language. They reported being familiar with British English (in terms of accent and vocabulary), which they found to be different from United States English. As such, five of the nine participants reported difficulties understanding their American professors, staff, and classmates. For example, Dillon struggled with understanding his professors’ pronunciation of English words, some terminology, idioms, and slang. He had this to say:

One of the things that I had a tough time dealing with was when instructors asked

questions. They would not give me enough time to process whatever they were

saying. I wish they understood that I needed to formulate my answer in my

language first and then translate it back into English. I always felt there was an

urgency for me to give a response too quickly. This created a lot of anxiety on

my part. When I gave out my answer too quick, the answer would be wrong.

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This made the instructors assume that I did not prepare for class or I was ignorant

about what they were talking about.

Nate reported difficulty understanding the various English accents associated with southern states where he was studying. He relied mostly on non-verbal communication to understand his professors and classmates. Despite this adaption, he reported that the language barrier affected his grades negatively. Likewise, Tay spoke about differences in the meaning of some words between his primary language and American English. He highlighted the importance of context in communication:

There are some words in English that don’t have the very same meaning as they

would have in my primary language. Sometimes, some gestures don’t have the

same meaning in America as they would in Zimbabwe. In communication, the

language is more than just the words but how you say them and when you say

them. The same goes for actions too. Meaning of words and actions can change

with context. Americans tend to value actual words that are spoken but as

Zimbabweans, we tend to value context.

Trevor expressed difficulty with understanding servers at restaurants because they were not communicating in English and when they attempted communicating in English, words were pronounced differently. He realized that, in his college town, foreign entrepreneurs owned and operated most of the food markets and restaurants. Another problem was that names of some foods were written in foreign languages and Trevor had to rely on pictures when buying food. He stated:

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I didn’t understand what they were saying. I was so blank. They just said out a

name and I agreed to buy whatever they said. We are so used to British names of

food and here in the United States, they use different names. It’s still English but

different English. For example, I used to say, “I want some chips.” They would

give me tortilla chips but what I wanted were fries, French fries. Here, potato

chips are called French fries. Biscuits are called cookies. Scones are called

biscuits. That’s confusing.

Stacy had different English language struggles. She reported having difficulties learning to speak with an American accent because her professors and classmates had problems understanding her Zimbabwean accent. She reported the unfairness of being academically judged by her professors and classmates based on her different accent. She stated, “I just spoke plainly like how we do in Zimbabwe, but most of them would start questioning my qualifications as though I didn’t qualify to be in college. Sometimes they would finish off my sentences when I was giving answers.” Stacy indicated that she had to “work extra hard to prove that I was not dumb.”

Cultural practices. Adjustment struggles associated with unfamiliar and almost clashing cultural practices were apparent in all the interviews and these ranged from clothing to gift giving practices. Some participants reported culture shock whereas others reported mere discomfort. Within a few semesters of being in the United States, all participants were able to adapt to some American cultural practices and interactions became relatively smooth. Regarding clothing, for example, Tay discussed the discomfort he felt when he was around some American females.

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We are not used to seeing people, especially ladies, wearing tight trousers or

walking in small shorts, exposing much of their bodies. That was a culture shock.

Can people live like this? I didn’t know where to look or whether I needed to

walk with my eyes closed. It was very uncomfortable. If that person approached

me to talk, I would just freeze or pretend that I didn’t know how to speak in

English.

Rose struggled with initiating and maintaining connections with members of the host country. She found people in the United States not as communal as Zimbabweans and she explained:

Back home, if you have any problems, you don’t even need to make an

appointment to see or talk to a family member. You just show up. Whereas here,

even if you want to visit a friend, you have to call and schedule an appointment. I

still don’t get it. Back home, I just showed up at my friend’s house any day, any

time. People here are not connected.

Trevor had similar sentiments. He had trouble with initiating friendships and expressed feelings of alienation. He discussed the possible reason:

Here in the United States, people are more [im]personal. For example, if I’m in

Zimbabwe and I get on a bus, I’ll go and sit in an area where there are other

individuals and initiate conversations. Here, people will get on a bus and sit as far

away from other individuals as possible. Even in classrooms, people always look

for seats that are far from other people. Sitting close to someone felt like I was

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invading their space. That made interactions difficult and it took me longer to

make friends.

Dillon expressed frustration related to lack of leisure time for college students.

He found that, in the United States, students were very busy and they were expected to take work home, even during weekends, leaving very little time for leisure activities.

Even if he were to get time to spare, he realized that most of the American leisure activities were not familiar. Before coming to the United States, Dillon’s leisure activities were mainly sports-related. He enjoyed playing and watching soccer, cricket, netball, and rugby but these sporting activities were either unknown or uncommon in the

United States. The common sporting activities in the United States were American football, basketball, and baseball that Dillon neither understood nor enjoyed. While in

Zimbabwe, Dillon also enjoyed going to comedy clubs. However, when he went to a comedy club in the United States, he was frustrated because he missed the humor due to cultural references.

Furthermore, Dillon experienced difficulties adapting to the egalitarian relationships in American marriages, particularly regarding gender roles. He realized that most Americans did not have distinct gender roles like Zimbabweans. He reported having to adapt, shifting from performing the traditional masculine duties to helping his wife with the traditional feminine household responsibilities.

I had not been in the kitchen much because, back home, my wife and other

females in the home did most of the cooking and cleaning. So I had to adjust, you

know, chip in and be in the kitchen as much as possible so that my wife could go

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to school. I started doing laundry and ironing clothes, her clothes and our

children clothes, too. I started looking after the children, helping them with baths

and feeding. I had not done this before coming to the United States. So, that was

a big shift in my responsibilities. It took me a while to get used to doing all this

but now I think I enjoy helping my wife and I find nothing wrong with that.

Simba had difficulties adapting to the ways Americans addressed and greeted each other. He expressed shock when he realized that American children addressed adults, even church leaders, using first names; college students also addressed their professors in a similar manner. He indicated that such a practice was considered rude and disrespectful in Zimbabwe. He reported being accustomed to the use of titles when addressing adults and authority figures. Furthermore, Simba reported being disturbed by the way people in the United States greeted each other. He was used to giving and getting firm handshakes and hugs every time he met or parted ways with other males while in Zimbabwe.

The first time I got to the United States, I was shocked when people of the same

gender would just use words to greet or welcome me. That appeared very cold. I

did not feel welcome. Some of the greetings and smiles felt forced. Some

American males would stare at me and feel extremely uncomfortable when I

extended my arm for a handshake or leaned in for a hug . . . What’s wrong with a

simple handshake? I don’t bite. Males can shake females’ hands but hugs, no.

Males can hug other males, females can hug other females, and we do that in

Zimbabwe.

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Valerie found discomfort during gift-giving interactions during Christmas, birthday, and graduation celebrations. She reported being expected to open gifts in front of people, a behavior she did not expect because, in Zimbabwe, gifts would not be publicly opened. She expressed her feelings.

I eventually had to adjust and started opening gifts in public but with unease.

People would even expect or ask me to read aloud the messages inside my cards

and everyone would be listening. I felt like everyone was invading my privacy.

Before I adjusted, I would get gifts, express my gratitude, and place the gifts in

my bag, intending to open them later when I got back to my apartment.

Theme 4: Limited Exposure to United States Mental Health Counseling

Interviews suggested that participants had limited exposure to United States mental health counseling. Several participants had never heard about professional counseling before arriving in the United States. Some knew about it but did not utilize services due to perceived cultural barriers or due to stigma. Others reported trust, diagnosis, and medication issues and they, therefore, perceived counseling in negative ways. Still, others perceived the efficacy of counseling even though they had no plans of utilizing the services. Only one participant reported receiving counseling services, just once.

Concerning his unfamiliarity with United States mental health counseling, Dillon could not recall anyone ever explaining to him what counseling was or how it was available to students who had problems. He added,

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I don’t think that [counseling] ever came up anywhere during our orientation

sessions or classes. I don’t remember any of my international friends advising me

to go for counseling when I had problems and I don’t remember any of them

going to a counselor for help. So, it was either the best kept secret or the other

students, whom we relied on for information, did not know about such services.

Unlike Dillon, Trevor knew about counseling services at his university but he had never utilized them. He explained,

Counseling offices were mentioned during new students orientation, just like

other services found on campus but I haven’t found a need to go for counseling. I

have my issues but I have not reached a breaking point when I need anybody’s

opinion about my issues. I have been taking care of my own issues. Therefore, I

cannot really judge whether counseling is helpful for me or not.

Like Trevor, Rose reported hearing about counseling but,

Culturally, that’s not something we do. We are not raised that way. Remember, I

told you that I was in a toxic marriage but I never went for professional

counseling. It was a family problem and our families were expected to help us.

Tay reported skepticism about counseling because

We tend to confide more in people that we know than people who are strangers to

us. When it comes to mental health issues, we don’t easily open up and talk to

strangers about our issues. I have a hard time trusting strangers.

Participants like Nate and Valerie discussed the stigma associated with counseling. Valerie summarized the key point:

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For me, words like counseling and mental health have a negative connotation.

Back home, they are mostly associated with people who have a defect or a disease

that limits their mental capacity. So, even if I were to have a need, I wouldn’t

want anyone to know that I went for counseling; otherwise, I would avoid it.

People would think I’m crazy or insane.

Simba perceived counseling as helpful but he would consider it the last resort because United States counselors might not relate to his problems due to cultural differences.

I think it [counseling] would be perhaps a good thing in the absence of all other

helpers like my family and friends. I always wonder if an American counselor

would be able to understand and relate to the issues that I have? Most people

don’t realize that most of our problems have a cultural explanation and solution

and American counselors may find these explanations and solutions rather

illogical. And so, how would they help?

Even though Stacy had no counseling experience, she believed in the efficacy of counseling. However, she discredited labeling (diagnosing) and the use of too much psychotropic medication. She explained,

I believe counseling might be helpful only if there is no diagnosis and medication,

unless the person is not coping. But here in America, everyone who goes for

counseling seems to be on meds. So sometimes, they become so dependent on the

meds that if they don’t take them, they get sick or get worse.

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Only one participant, Elite, utilized counseling services, only one time, while in the United States. He stated that a doctor at the Student Health Center, who attended to him when he was ill, referred him for counseling:

When I visited the clinic, the doctor checked me and told me that my blood

pressure was high. I got medication and the doctor referred me for counseling. I

was seen at the counseling center a few days later. The American counselor was

very friendly. We had a good discussion. I could see in our discussion where we

were coming from and where we were going. I could tell she had done her

research. I had done some self-diagnosis before going there and what she told me

was exactly what I thought was going on. However, the challenge is dealing with

people like me. I am an international student; my culture is totally different from

hers. Of course, I wasn’t expecting her to understand everything. Most of the

things she said made sense and some of the recommendations somewhat helped.

For example, I found a hobby, joined a student club, and interacted more with

other international students.

Theme 5: Self-Reliance and Informal Supports Leading to Acclimation

Eight of the nine participants discussed how they were uncomfortable communicating their problems openly with anyone but family members. They reported keeping their struggles to themselves and they did not seek professional help. They discussed, at length, how their culture values privacy, particularly with issues concerning life struggles and mental health. They reported non-existence of professional counseling

112 for the mainstream population in Zimbabwe except for the severely mentally ill and the bereaved. Elite seemed to have captured the central ideas discussed by most participants:

We are not very open when it comes to our problems. Unlike the Americans who

are very open and straightforward. They can tell you all their problems even

when you don’t know them that well. For example, they go for counseling and

spill every issue they have. I cannot do that and why should I? Our problems are

our problems. Why should people outside my family know? Sometimes, when

people ask if we are okay, we pretend like all is well. But the truth is, we just

don’t wish to share.

Dillon shared a similar viewpoint and reported that his socialization in the

Zimbabwean culture informed his decision not to share his problems with people outside his family. He added,

I don’t have hope or high expectations for a stranger to come up with a solution

that can actually help me. They are not my family and I don’t trust them. The

counselors we have in Zimbabwe come in the form of form of family elders and

not professionals.

Likewise, Trevor shared the same sentiments and stated:

So you find that when people here face problems, they go for counseling but most

people from Zimbabwe will not go. If I am forced to go, I will simply close off

because I find it impersonal to talk with someone who has no stake in my life. He

is being paid and personally not interested in my problems. So, whatever he is

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going to prescribe, he is not an invested partner in all that is happening around my

life.

Therefore, to resolve their problems while in the United States, participants reported self-reliance and informal supports such as fellow students, host families, and community volunteers who were on their campuses during international student orientation sessions. They also reported finding comfort in prayer and joining churches that exhibited communal practices similar to Zimbabwean social practices.

Regarding limited resources, participants shared that they resolved their problems by utilizing various strategies. All participants reported calling family members in

Zimbabwe for emotional support, reconnecting with friends and family in Zimbabwe via social media, and joining local churches for fellowship. They also sought help from other students, both domestic and international. Several other coping strategies were utilized by specific individuals, for example, Stacy reported delaying taking classes while Trevor reported relying on public information provided on the Internet, on the television, billboards, and flyers. Rose, Valerie, Simba, Stacy, and Tay resorted to using trial and error, keeping problems to themselves, and holding on to hope while Nate used reflections on how things could have been worse if they were back in Zimbabwe to cope with financial hardships. He reported constantly reminding himself that he is “actually better off struggling in the United States than a million other people struggling back home. So, I put things into perspective.”

Dillon, Trevor, Rose, and Valerie relied on God and reported praying as their main coping strategy. For example, Valerie believed in destiny and holding on to her

114 faith is all she needs to get through school. She stated, “God brought me to the United

States to get the best education and He will help me accomplish my goal. I need to worship and continuously pray.” Similarly, Dillon believed that being a Christian helped him “overcome most of the troubles and the stress that comes with being an international student, especially praying and just surrendering everything to God.”

Trevor used a different strategy. He decided to get married to a fellow

Zimbabwean international student in order to cope with loneliness and cultural challenges:

I had to quickly get married to somebody, another Zimbabwean student. This

enabled me to have constant company and to freely communicate certain things

and understand certain things from somebody who spoke my primary language

and whom I could connect with, culturally. This was somebody who could

understand some of the situations that I was going through. I mean, we shared the

same culture. So, this new connection provided me with a safety net in terms of

my social adjustment in the United States. I should also mention that two

incomes were better than one.

Rose discussed at length how her boarding school experience, positive self-affirmations, and her personal strengths played a major role in coping with life away from home:

I went to boarding school when I was 9 years old. We were taught to be

independent. Yes, we were told to be self-reliant and we had to do that to survive.

Now, you tell yourself, hey, no matter how dark the day is, you paste a smile on

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your face and move on. It was a matter of perseverance. I just kept telling myself

to keep my eyes on the ball and hope that things will work out and eventually,

they did. I have this optimism that always propels me to remember that Rome

was never built in one day. I think I have mental toughness. It also comes from

how, we, Zimbabweans were raised.

Similarly, Elite discussed how he developed resilience while growing up in

Zimbabwe and how this resilience helped him cope with his difficult transition from

Zimbabwe to the United States. He added:

In spite of all the problems, deep down, I knew things were going to work out,

somehow. Whenever I was going through a difficult situation, I used to write

some notes to myself. I would tell myself that this is what you set out to do in

America and things have to work out. I have been through worse situations

growing up and I made it. And so I will make it here too.

Participants also discussed various strategies they used to cope with issues related to navigating the United States’ academic environment. They reported learning to assimilate to United States’ academic and classroom behavior expectations. For example, Tay, Trevor, and Stacy took the initiative to self-teach technology usage, from basic keyboarding skills to surfing the Internet. They also sought help from office staff, library staff, and computer laboratory student workers. Elite and Dillon took informal sessions on United States classroom behavior expectations. For example, Elite gave credit to “host families and college ambassadors (student mentors) who provided role- play sessions that simulated American classrooms. These were not formal sessions but

116 full of fun and very informative.” Other coping strategies reported by Stacy, Simba,

Elite, and Rose were doing extra credit assignments, sacrificing sleep in order to complete assignments, and finishing studies in the shortest possible time.

All participants reported seeking academic-related help from other international students. Dillon highlighted such help:

It was much better finding out from other international students how to survive

and be successful in the American education system. We would also ask them if

they encountered similar problems and how they resolved the problems. Some

would voluntarily share their experiences. Just talking about it helped to know

that we were not the only ones struggling.

To cope with socio-cultural barriers, particularly language issues, participants reported talking to as many people as possible to get familiar with different accents, vocabulary, and American slang. Some participants listened to videos in which

Americans were speaking, asked others to repeat what they were saying, and made use of public information posted on the Internet. Others, like Stacy, relied on non-verbal communication. She explained,

Non-verbals helped much but some of the gestures seemed offensive. But I

learned. I also did and still do lip-reading. I make sure I’m looking at the

speaker’s mouth, otherwise, I miss half the conversation. People expect me to

maintain eye contact but I focus on the mouth.

Valerie attributed her ability to cope with socio-cultural barriers to her boarding school experience where she interacted with teachers and staff from Western cultures.

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Because I had been in boarding school while I was in high school back home, we

had expatriate teachers from overseas (Germany, Canada, and United Kingdom)

who introduced and modeled Western culture to us. So, some of the American

cultural practices were not very different from what I was exposed to in high

school. I cannot say I had culture shock when I came to the United States.

Chapter Summary

It seemed evident, from the interviews, that participants had varied experiences as they adjusted to life in the United States. Excerpts used in this chapter provide clear evidence that upon arrival in the United States, participants had limited resources

(finances, housing, food, transportation, and social support). In addition, navigating the

United States’ academic environment appeared to be a challenge for most participants who cited United States’ teaching approaches, academic expectations, classroom behaviors, technology, and interactions with professors as the major concerns. Excerpts also suggest that participants encountered socio-cultural barriers ranging from the use of

English language to general cultural practices. Furthermore, participants seemed to have limited exposure to United States mental health counseling and perceived cultural barriers to professional mental health counseling. Therefore, to resolve or cope with their problems, participants were either self-reliant or utilized informal social supports.

In the next chapter, I discuss results of this study in relation to previous literature on adjustment experiences of international students and their perception of United States mental health counseling. Implications for higher education, faculty, clinical mental

118 health counselors, and international students (prospective and current) are provided. In addition, limitations of this study and future directions in research are presented.

CHAPTER IV

DISCUSSION

Being an international student is not without its challenges. Literature provides evidence that the majority of international students experience a range of adjustment issues, from daily life hassles to cultural barriers, that can impact their academic success, psychological well-being, and overall study abroad experience (NIMH, 2012; Wu et al.,

2015). Many of these studies have been primarily quantitative (e.g., Al-Darmaki, 2011), conducted with Asian and Hispanic students (e.g., Birnbaum, Cardona, Milian, &

Gonzalez, 2012; Komiya & Eells, 2011; McRaith, 2009; Li, Wong, & Toth, 2013; Wu et al., 2015), and results have been overgeneralized to all international students. To avoid such overgeneralizations, there is need to focus on international students from specific countries. Therefore, the current study obtained data only from Zimbabwean international students who are studying in the United States. The study was guided by the following research questions:

1. What are the adjustment experiences of Zimbabwean international students as

they study in the United States?

2. What are the Zimbabwean international students’ perceptions of United States

mental health counseling?

In this chapter, I discuss the following: (a) summary of findings in relation to previous literature; (b) implications for higher education, clinical mental counselors, faculty, and Zimbabwean international students; and (c) limitations of my study. In addition, I provide directions for future research and a conclusion to the study.

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Summary of Findings in Relation to Previous Literature

Previous research has suggested that many international students face unique challenges as they study abroad and there are considerable variations across individuals

(Masgoret & Ward, 2006; Smith & Khawaja, 2011). For example, many international students identified challenges such as unfamiliar food and climate (Johanson, 2010), financial distress (National Association of Foreign Student Advisers, 2011), English language problems (Institute of International Education, 2014), and academic problems

(Willis et al., 2003; Zhai, 2004). Some of them identified challenges such as loss of social status and immigration concerns (Wang & Mallinckrodt, 2006), limited support systems (Mori, 2002; Sümer et al., 2008), and homesickness (Araujo, 2011; Constantine,

Anderson, et al., 2005). Other international students reported discrimination

(Constantine, Kindaichi, et al., 2005; Hanassab, 2006; Poyrazli & Lopez, 2007), constant pressure to acculturate (Duru & Poyrazli, 2007), distress associated with efforts to maintain their own cultural identity (Sue & Sue, 2008), personal crises happening at home, such as illness or death among family members and friends, and parental discord or divorce (Mori, 2002). Results of this study are comparable to results of previous studies. Even though participants were asked to share their adjustment experiences as they studied in the United States, they seemed to focus on their negative experiences.

Participants in this study provided unique stories about their adjustment experiences as they studied in the United States. They also had varied perceptions of the

United States mental health counseling. However, they shared many commonalities from which the following themes emerged: (a) limited resources, (b) navigating the United

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States’ academic environment, (c) socio-cultural barriers, (d) limited exposure to United

States mental health counseling, and (e) self-reliance and informal supports leading to acclimation.

Limited Resources

The data in this study suggested that participants faced challenges associated with limited resources (finances, housing, food, transportation, and social supports) during the first few months upon arrival in the United States. It appeared as if participants lacked information about the cost of living in the United States prior to their arrival. Some participants realized that their sponsors underfunded them while others realized that the money they had saved for use in the United States was not adequate for both college tuition and basic needs. Like other international students in previous studies, participants in this study did not qualify for educational financial aid offered by the United States government or most scholarships offered by American private sponsors (Constantine,

Kindaichi, et al., 2005; Poyrazli & Grahame, 2007).

Experiencing limited finances was not surprising because all of the participants moved to the United States during the period (from mid-1990s to date) when there was an economic crisis in Zimbabwe (Mazuru, 2014). The hyperinflation in Zimbabwe and the foreign currency exchange rate of US$1 to approximately two trillion Zimbabwean dollars, at its worst in 2008 (Mazuru, 2014), seemed to be a major contributor to participants’ financial hardships. The economic crisis resulted in foreign currency shortages in Zimbabwe, leading to restrictions in sending money outside the country. To make matters worse, the Zimbabwean government decided to demonetize (retiring its

122 almost worthless local currency) in favor of a multicurrency economy, including the

United States dollar, South Africa rand, and Botswana pula (Mazuru, 2014). This meant many Zimbabweans, including some participants of this study, lost most, if not all, of their savings due to the new currency exchange rate at that time. So, for some participants, the money they had in their savings banks in Zimbabwe and anticipated to fall back on could not sustain their needs while studying in the United States. Since 2009 until present, Zimbabwe has had no currency of its own; it has to rely on paper currency imported from other countries, and this, apparently, has led to deflation. Such a situation would make it difficult for participants’ families in Zimbabwe to support them financially while studying in the United States. Furthermore, some of the participants’ sponsors

(such as private companies) in Zimbabwe reneged on their financial promises. For participants who did not have graduate assistantships, those who held non-working visas, or those whose visas permitted them to work for limited hours on their campuses, life became difficult because they could not meet their basic needs.

Limited finances seemed to be the underlying issue that affected housing and transportation. If participants had adequate funding, some of their everyday struggles would have been minimal. Just like participants in Poyrazli and Grahame’s study (2007), participants in this study were surprised that, upon arrival in the United States, they were left to fend for themselves with no place to go. The majority of participants in this study did not have a place to stay upon arrival in the United States due to not having housing set up prior to their arrival and due to unexpected expenses associated with housing.

They had to live in hotels during the first few weeks of being in the United States,

123 resulting in exhaustion of most of their funds. When they found alternative housing such as apartments or houses, most participants had problems raising the security deposit and the first month’s rent that property owners required before moving in. Moreover, for these students, setting up a decent living space would involve other expenses related to basic supplies ranging from bed linen to furniture.

In addition, none of the participants had cars upon arrival in the United States.

They lived off-campus and access to transportation was vital for commuting to and from their campuses as well as getting supplies such as household items and groceries.

Participants had to rely on public transportation, particularly buses, that they reported as not efficient and routes were confusing. Some participants lived in areas that had no bus routes and so they used taxis, a method that further drained their wallets. Transportation problems impeded efforts of studying or working on campus at night because, on most campuses, buses had limited services hours.

Furthermore, data suggest that participants experienced food challenges. Most of the foods were unfamiliar, names used for some foods were foreign, and for the most part, participants did not know where to get familiar food upon arrival in the United

States. This was not surprising because different nations and cultures tend to have foods that are unique in terms of ingredients and recipes and adapting to unfamiliar foods can be a concern for international students (Ritz, 2010). As discussed by participants,

Zimbabwean cuisine is comprised of heavy starch, cooked green leafy vegetables, peanut sauce, and meat stews. These foods seemed different from the light starch meals, uncooked vegetables (salads), and dry meats associated with United States cuisine. So,

124 lack of a basic need such as familiar food appeared to be one of the major concerns for

Zimbabwean international students as they tried to adapt to life in the United States.

Data gathered for this study also echo results of other studies

(Hechanova-Alampay, Beehr, Christiansen, & Van Horn, 2002; Johanson, 2010;

Poyrazli & Lopez, 2007; Tochkov et al., 2010; Stroebe et al., 2002) that suggested loneliness and isolation, resulting from limited support systems, to be the most predictive factors of poor cross-cultural adjustment for international students. Limited supports can have an impact on adjustment experiences of international students, including emotional and psychological disturbances such as homesickness (Onabule & Boes, 2013; Poyrazli

& Lopez, 2007; Sovic, 2008), anxiety and stress (Tochkov et al., 2010), as well as depression and low self-esteem (Gu, 2011).

It is important to know that strong support systems are very important for international students’ adjustment, adaptation, and well-being (Hendrickson, Rosen, &

Aune, 2011; Smith & Khawaja, 2011). However, participants in this study seemed disengaged from their primary support systems such as families and friends when they moved to the United States and their efforts to connect with domestic students and other members of the host communities seemed unsuccessful. Failure to make connections was attributed to cultural barriers by many participants and these barriers are discussed later in this chapter.

Other participants asserted that they did not have time to engage their American peers and maintain friendships outside of class due to heavy academic demands.

Establishing friendships appeared difficult for participants regardless of length of time

125 spent in the United States. Lack of friendships and not being able to interact with and get support from families in their home countries seemed stressful for participants. Such distress was not surprising because Zimbabweans come from a collectivistic society in which connections and interdependence are important values (Hofstede, 2011; Hofstede

& McCrae, 2004). Given their values, they expected Americans to be overtly supportive regarding the various challenges they were facing. They reported discovering that in the

United States, people tended to be more individualistic and less dependent on others than in Zimbabwe. When they failed to establish connections, some participants looked for and reached out to other Zimbabwean students already studying in the United States and others joined churches to fulfill their social and emotional needs.

As indicated in previous studies (e.g., Poyrazli & Grahame, 2007; Ritz, 2010), lack of resources in a place where international students are far from their families and friends may be the most challenging aspect of their study abroad experiences. It appeared as if it was hard for Zimbabwe international students to enjoy their arrival in the

United States and to focus on their academic goals when they had limited resources to meet their basic needs. It is, therefore, important to understand the basic daily struggles that Zimbabwean international students may go through as they study in a foreign country in order to facilitate easier transition into United States’ colleges and universities.

Navigating the United States’ Academic Environment

As discussed in Chapter 1, Zimbabwe was a British colony from 1890 to 1980.

Even though it has been over 30 years since it gained its political independence, the

Zimbabwean education system is still modeled around the British education system

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(Tofa, 2012). Because of their familiarity with the British education system, it appeared as though participants made assumptions that Western countries have similar education systems and so, they did not report making efforts to find out and orient themselves to the

United States’ education system prior to their arrival. However, it became clear during interviews that participants lacked understanding of the United States’ academic system.

The realization of differences between the Zimbabwean and the United States’ education systems occurred quickly and participants had to learn to navigate the United States’ academic environment. It took some participants more than one semester to figure out the dynamics of their new academic environment.

It is not surprising that meeting academic demands has been reported as one of the most overwhelming difficulties for international students (Zhai, 2004). Participants in this study were no exception. As discussed in Chapter 1, participants came from a country characterized by a bottleneck system of education that is exam-oriented. When they came to the United States, participants realized that, besides exams, their grades were also based on presentations (individual and/or group), discussion assignments

(face-to-face and/or online), experiential learning assignments, general class participation, and class attendance. Unfamiliarity with these other forms of academic assessments and the frequency with which they were given appeared to induce anxiety and stress in most participants. In addition, participants struggled with challenges associated with maintaining their immigration status requirements. They reported being required to carry a fulltime class load (at least 12 credit hours per week, for undergraduate students and 9 credit hours per week, for graduate students) in order to

127 maintain their visas. This requirement seemed to be another stress inducing experience for participants. Participants reported working on multiple assignments for multiple subjects in the midst of trying to cope with other non-academic daily life issues.

Furthermore, participants had to adapt to different teaching approaches used in the

United States. Participants reported that the lecture method was the most prominent teaching method in Zimbabwean schools, colleges, and universities. It appeared as though Zimbabwe teachers and professors were the main, if not the only, source of academic information. Participants reported that their Zimbabwean teachers and professors mainly lectured and provided notes to students. This contrasted with the

United States’ teaching approaches in which professors facilitate learning and encourage sharing of ideas and opinions through class discussions, critical thinking, creativity, and collaborative projects (Hofstede et al., 2010). In addition, when they came to the United

States, participants reported being expected to use computers to type all assignments, access educational resources, and complete some assignments online, for the first time.

Participants reported that computers were uncommon in Zimbabwe during the period when they attended school there. Learning computer skills seemed quite challenging for participants, resulting in frustration, incomplete assignments, and poor grades for some of them.

Rienties and Tempelaar (2013) asserted that the optimal design of educational systems has important dependencies on cultural backgrounds of that society. As such, the directive approach to teaching found in Zimbabwean schools aligned with the

Zimbabwean value of giving reverence to experts and authority figures (Zemba et al.,

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2006). This means, in Zimbabwe, students learn from teachers and not from each other, do not question or challenge teachers, speak only when spoken to, and do not interact with teachers outside class. As asserted by Greenfield et al. (2006), students who come from a collectivist society may wait for directions to follow instead of asking questions, may need to fit into the surrounding culture rather than feeling comfortable standing out, or may be more passive than students from an individualistic society. Data from this study echo the above assertions. Participants viewed their professors as experts who were supposed to gather information and hand it down to them to study. They were concerned about crossing boundaries. They found it uncomfortable asking questions or challenging their professors. They also found it uncomfortable visiting professors privately in their offices because they were unaccustomed to communicating and interacting with their professors informally. However, participants had to adapt to their new environment. They found themselves in unfamiliar and challenging roles of peer teaching (leading discussions and presenting topics to classmates). Some of them found themselves in egalitarian relationships with their professors where they had to collaborate on projects and co-present at conferences.

Given that their experiences in their previous institutions shaped their ideas, behaviors, and skills, participants did not feel confident in their new relaxed learning environments because they were used to more structured environments and stricter classroom rules. Therefore, some of them were confused about side conversations among students that some professors allowed during class, students’ rude and disrespectful comments towards some professors, and addressing professors by their first names

129 instead of last names or job titles. Participants were confused about why domestic students dressed casually for class (from sweat pants to tank tops to flip-flops) because they were required to dress semi-professionally or professionally when they attended classes in Zimbabwe. They found behaviors such as eating, drinking beverages, or chewing gum in United States classrooms inappropriate, distracting, and disrespectful.

Even though they were concerned about these conduct issues, participants reported tolerating their new learning environments.

Socio-Cultural Barriers

Given the cultural differences between their home countries and the foreign countries in which they study, it is not surprising that international students often face culture shock and social adjustment as they study abroad (Araujo, 2011; Berry, 2008).

Interview responses from this study suggest the same sentiment; participants had interaction concerns and insecurities about cultural disparities between Zimbabwe and the

United States, particularly language barriers and other general cultural practices.

As indicated in previous studies, English language deficiency has been reported as one of the greatest issues hindering smooth adjustment for international students who study in countries whose primary language is English (Andrade, 2006; Galloway &

Jenkins, 2009; Zhang & Goodson, 2011). Anxiety and worry about lack of understanding and misinterpreting of the English language has been cited in studies conducted by Bista

(2011) and Mori (2002). Zhai (2004) found that most of the language difficulties have been due to differences in accent, enunciation, slang, and use of special English words.

Terui (2011) found that, at times, a low English proficiency level resulted in a negative

130 impression from professors because the professor perceived that the international students were not well prepared for class. Ryan (2005) found that international students were treated as less intelligent by their professors and peers due to their accents or difficulty expressing thoughts. Participants in this study were no exceptions.

All participants’ primary language was not English and so their struggles with the

English language were not surprising. Even though they were familiar with British

English, pronunciation and spellings of many words were different from the American

English. Participants found it challenging to adapt to the colloquial (versus the formal

British English) that American professors and classmates used, especially in formal classroom presentation and written assignments. Differences in accents between

Zimbabwean international students and their American professors and classmates compounded difficulties with understanding each other. Some participants struggled with keeping up with the spontaneous responses expected of them during class discussions. They expressed frustration regarding lack of opportunity to adequately process and translate information, back and forth, between English and their primary languages. They appeared frustrated about having to catch up with class material when they were on their own, usually after class, resulting in a pile-up of homework. It seemed apparent that English language difficulties had an impact on participants’ adjustment experiences as they studied in the United States. In spite of these English language difficulties, data from this study suggest that United States’ professors made very minimum effort to understand or adjust their teaching approaches to ensure fair learning opportunities for international students.

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It also appeared as though other cultural barriers, other than English language issues, impeded the process of adjusting to life in the United States. Just like other adjustment experiences discussed earlier, the impact of these cultural barriers on participants varied across individuals. For example, three participants felt excluded in classrooms or other social settings where culture-specific humor was used and participants lacked the socio-cultural context associated with the humor. During such moments, a sense of discrimination seemed inevitable for those international students.

Similarly, three other participants felt alienated and homesick, as they found Americans not as communal as Zimbabweans. This experience was not surprising because, as discussed earlier, Zimbabwe is a collectivistic society in which strong relationships and interdependence are valued (Manwa et al., 2013). This contrasts the United States’ culture that tends to value individualism, promote autonomy, and expect individuals to be responsible for themselves (Hofstede & McCrae, 2004) and take personal control over their own life situations (Brewer & Chen, 2007).

In addition, one male participant felt discomfort around American females who wore very short and very tight clothes and those who exposed most of their bodies. He was used to seeing Zimbabwean women wearing traditional loose and below-the-knee length skirts and dresses. When tight or short clothes were used, rectangular pieces of cloth (mazambia) would be wrapped loosely around female bodies down to the ankles.

This male participant reported that, in Zimbabwe, too much skin exposure and tight clothing for women were considered sexually provocative and associated with prostitution. It is important to understand that attitudes about clothes and dress codes are

132 socially constructed and dress can be used to mediate cultural beliefs and values (Manwa et al., 2013). As discussed in Chapter 1, modest dressing for women is a cultural value in collectivistic societies and older people tend to expect conformity and preservation of cultural values. This may explain why the oldest male participant was concerned about the liberal dressing he observed among females in the United States.

Another male participant experienced difficulties adapting to egalitarian relationships in marriage, particularly shifting and sharing of traditional gender roles.

The participant had not engaged in the traditional feminine roles of cooking, cleaning the house, doing laundry, or taking care of children until he was in the United States. He observed his American male colleagues and acquaintances engaging in domestic chores and they questioned why he was not assisting his wife, who was also a college student, with household chores. Considering the Zimbabwean patriarchal social structure in which social roles are highly gender polarized (Machingura, 2006), it was not surprising that this participant only focused on the traditional masculine responsibilities (fending for and protecting the family) upon arrival in the United States and felt degraded by doing domestic chores. As discussed earlier, in patriarchal societies, traditional gender roles are difficult to switch or shift (Mutekwe, 2007) and this may explain why it was not easy for the male participant to adapt to the new traditionally feminine responsibilities he was expected to undertake while in the United States.

As mentioned earlier, participants had to get used to hearing younger people addressing older people, particularly professors and church leaders, by their first names.

This seemed the norm in the United States but a rude and disrespectful gesture in

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Zimbabwe. Some participants reported their reluctance to adapt to this behavior and chose to maintain the familiar way of addressing elders and authority figures, that is, using social or job titles, accompanied by last names. In addition, participants had to get used to greeting others using words only without handshakes and/or hugs. They reported being used to seeing individuals of the same gender hug as a form of greeting. They also reported it customary for younger people to initiate greetings, both verbal and non-verbal and for younger females to curtsy when they extend their hands to greet adults. This may explain why participants were surprised that Americans greeted each other only with words. Participants reported difficulties with discontinuing their greeting customs to adapt to United States forms of greeting.

Limited Exposure to United States Mental Health Counseling

Literature indicates that many international students lack exposure to professional mental health counseling services in their home countries (Araujo, 2011). When they study abroad, international students may be unaware of the existence of counseling services or lack knowledge about how to find or when to utilize such services (Mori,

2002). Some of them may have a misunderstanding of professional counseling due to the stigma they associated with mental health problems (A. W. Chen et al., 2009;

Constantine et al., 2004). Others may lack trust in helping professionals due to cultural differences (Araujo, 2011). As a result, many international students are less likely to utilize professional mental health counseling services (Ahmed et al., 2011; Araujo, 2011;

Mortenson, 2006; Yeh & Inose, 2003) even though they tend to experience more adjustment problems and need more support than domestic students, in general (Mori,

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2002). For those who seek services, termination of services tends to be premature (Mori,

2002). Most of the time, they feel more comfortable and prefer to seek help from family and friends (Araujo, 2011; Constantine, Kindaichi, et al., 2005; Zhai, 2004).

Results from this study support previous literature. The majority of participants reported being unaware of professional counseling before and upon arrival in the United

States. For example, one participant reported never knowing or hearing about anyone who used counseling services. He also reported no one advising him to go for counseling when he had problems. Likewise, some of the participants appeared to misunderstand

United States mental health counseling. For example, one participant perceived United

States’ counselors as impersonal, not invested in their clients’ lives, and practicing counseling because of money. Other participants perceived professional counseling as a service that was needed only when someone had reached a breaking point. In addition, several participants reported being skeptical about counseling due to stigma and issues with diagnosis and medication. Others reported lack of trust and perceived that United

States’ professional counselors would not understand their struggles because they were not family and they were not Zimbabwean.

These perceptions of United States mental health counseling made sense because literature indicates that, in Zimbabwe, professional counseling is almost non-existent for the mainstream population, but for the severely mentally ill (IRIN Global, 2004;

Thornicroft et al., 2007). In addition, because participants indicated coming from a culture that valued privacy and has close social networks, it made sense that they reported being unwilling and not open to sharing their personal problems with professionals,

135 whom they regarded as strangers. Unfamiliarity with and limited exposure to United

States mental health counseling seemed to suggest negative perceptions of services by participants. However, after their arrival in the United States, some participants became aware of the purpose of counseling. They perceived counseling as helpful and important, but they still reported that it should be used as the last resort.

Literature also indicates that some international students perceive psychosomatic complaints as medical concerns (Mori, 2002) and feel more comfortable seeking medical care services rather than mental health services (Nina, 2009; Onabule & Boes, 2013).

This may explain why the only participant who utilized counseling services sought medical services first when he was struggling with homesickness and isolation. He reported being referred for counseling by a medical doctor and he utilized the services only once.

Based on the above discussion, the majority of participants in this study had limited exposure to the United States mental health counseling. They did not use counseling services to address the challenges they faced as they adjusted to life in the

United States. Instead, they reported seeking help from informal supports such as family and friends.

Self-Reliance and Informal Supports Leading to Acclimation

As discussed in Chapter 1, many international students experience unique transitional challenges when they study abroad (Duru & Poyrazli, 2007; Institute of

International Education, 2014; Johanson, 2010; National Association of Foreign Student

Advisers, 2011; Wang & Mallinckrodt, 2006). If left unresolved, some of these

136 challenges can negatively impact academic success, socialization, and psychological well-being (Araujo, 2011; Vogel et al., 2007), resulting in withdrawal from school, substance abuse, and physical deterioration (NIMH, 2012). It is, therefore, important for international students to resolve or find ways to cope with their adjustment challenges as they study abroad. It is also important to understand that cultural differences in perceptions of and reactions to challenges may determine the coping strategies that international students use (Araujo, 2011; Onabule & Boes, 2013).

As discussed in the previous section of this chapter, participants were reluctant to share personal problems with non-family members and close friends. This reluctance may have contributed to their reliance on informal supports such as family, friends, college and university staff, and host families. Participants also reported seeking help from other students (both domestic and international) with whom they became acquainted and former classmates (studying in the United States, Canada, and Zimbabwe) whom they contacted via social media. One participant reported getting married, in the United

States, to another Zimbabwean international student with whom he shared a common language and culture because he felt alienated and had difficulties making friends with domestic students. Using familiar informal supports was not surprising given that participants indicated coming from a culture that valued close social networks.

Reluctance to share personal problems also appeared to explain why participants adopted other active and deliberate ways to acclimate to life in the United States. They reported being self-reliant and taking initiatives to educate themselves about United

States’ culture. For example, several of them actively sought information and developed

137 skills from the Internet, billboards, flyers, and television. Some of them taught themselves how to use computers, fax machines, printers, and copiers. Others reported resilience, perseverance, being optimistic, trial and error, reflecting on experiences, and holding on to hope, as other strategies they used to cope with challenges of studying in a foreign country.

Some participants, who reported being in boarding school during their high school years in Zimbabwe, appeared to have fewer adjustment challenges and reported being more independent than those who did not report being in boarding school. They also reported easier academic and social adjustment because their boarding school expatriate teachers exposed them to some aspects of Western culture and education system.

In addition to informal supports and self-reliance, most participants reported placing their trust in God and using prayer to cope with every day challenges. They reported seeking financial and material help from churches. This made sense because all participants reported being Christian and being comfortable with the communal, interdependent lifestyle exhibited by the churches they joined while in the United States.

Implications

This study aimed at understanding the adjustment experiences of Zimbabwean international students and their perception of mental health counseling in the United

States. It is important to recognize Zimbabwean international students’ individual perspectives regarding the factors involved in their adaptation process because they represent a unique cultural background and have unique personal experiences. This study has provided additional knowledge to existing literature on adjustment experiences of

138 international students and new insights that may help enhance multicultural knowledge and skills for everyone who works with Zimbabwean international students. These insights and knowledge have important implications for creating and implementing programs as well as providing services and resources likely to assist Zimbabwean international students with personal, academic, and emotional support. The next section provides implications for higher education, counselor educators and other university faculty, clinical mental health counselors, and Zimbabwean international students (both prospective and current).

Implications for Higher Education

One of the most important goals of the United States’ higher education system is to enroll international students for academic, economic, and cultural purposes (Institute of International Education, 2013). It is therefore important that higher education plays a significant role in embracing international students and maintaining their well-being.

Based on the results of this study, many participants lacked general information about the

United States’ academic system and general culture. I think it would be helpful for

United States’ college and university personnel to get exposure to the culture and academic system of the countries from where their international students originate. For example, this exposure could be via visits to prospective international students’ homelands by teams of college and university personnel (comprised of, for example, an admission counselor, an academic advisor, a mental health counselor, and a faculty member). This exposure could help with admission and some academic decisions as well as help put in place programs, resources, and services likely to facilitate international

139 students’ adjustment in the United States. Such exposure could foster awareness of potential challenges likely to be faced by international students. While still abroad, the college and university personnel teams could orient prospective students to such important aspects as the United States’ climate, availability and accessibility of basic resources, work requirements and restrictions, general cultural values, and the academic system. The teams could also provide checklists of pre-arrival requirements that international students need to know and satisfy before they embark on their journey to study abroad. Pre-arrival preparation could alleviate prospective students’ apprehension about moving to a new country. Upon return from abroad, the teams could host intercultural workshops and seminars for the rest of the college or university community to reflect on their (team members’) experiences and to share relevant cultural and academic information. Such workshops and seminars could foster cross-cultural awareness, understanding of the adjustment experiences of international students, and improvement of empathy and responsiveness to the needs of international students. All these efforts could also help with the development and implementation of relevant programs and services for international students.

If funding such trips is too expensive, United States’ colleges and universities could offer professional development workshops or informal cultural exchange sessions involving diverse groups within the college or university communities. Such efforts could enhance cultural awareness and strengthen intercultural sensitivity. In addition, friendships could develop and all involved could learn the value of and appreciate

140 cultural diversity. International students, in particular, could gain insight into the United

States’ social expectations and cultural mores for better cross-cultural adjustment.

Based on the results of this study, many participants lacked general information about availability and accessibility of basic resources, work requirements and restrictions, and academic expectations. Even though many United States’ colleges and universities provide pre-arrival information on their websites, the information may not be accessible to many international students. As suggested by results from this study, some international students may not have access to computers in their home countries or they may lack computer skills to access the information. United States’ colleges and universities may need to consider mailing hard copies of pre-arrival information to international students, especially to countries from which paper applications are still accepted. In addition, oftentimes, the websites do not make information accessible for students with disabilities. I think all college and university websites should provide accessible documents that can be accessed by screen readers or other assistive technology so that students can have important information likely to help with their preparation to study abroad. In addition, international students could benefit from pre-arrival information regarding the general cost of living, transportation, banking system, counseling services, university rules and regulations, and the United States’ cuisine.

Furthermore, some international students could benefit from pre-arrival information written in other major world languages, in addition to English.

Many United States’ colleges and universities provide orientation sessions for incoming international students and the goal is to help these students integrate into their

141 new academic and social environments and to inform them about immigration essentials

(Duke, 2014; Madden-Dent & Laden, 2015). Based on the results of this study, some participants reported that the orientation sessions they attended were generic and did not take into account the uniqueness of students’ cultural backgrounds and lived experiences.

These participants also reported that information was given all at once, over a short period. It would be very helpful, therefore, for higher education institutions to consider providing culture or region-specific orientation programs that are relevant to the needs of specific cultural groups of international students. It would also be helpful to have several spaced-out orientation sessions throughout the first few weeks of the first semester so that each service/information provider holds separate interactive sessions with smaller groups of students. Involving domestic students in these orientation sessions would also be important as this could create an environment for multicultural interactions.

Results of this study also suggested English language barrier as one of the adjustment challenges of Zimbabwean international students. Even though United

States’ higher education is already addressing language barriers by offering English as a

Second Language (ESL) courses to support international students’ language proficiency, it is important to understand that many international students come from cultures that acquire knowledge, including a second or third languages, via informal settings and informal methods. In addition, many international students come from multiple language backgrounds that have varied grammar and syntax rules that are often different from

English. It is, therefore, important to understand that prior language development plays a key role in determining how well one acquires a second or third language (Genesee,

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Lindholm-Leary, Saunders, & Christian, 2006). Moreover, it takes time for anyone to develop language skills and yet international students are expected to grasp a foreign language and to use it proficiently (for example, writing a graduate level paper) when they are only exposed to the English language during class hours, for a short duration.

Sometimes, learning a new language in formal settings such as ESL courses may inhibit these students due to the evaluative nature of the learning process. I think additional exposure and practice via supplemental informal conversation sessions that familiarize international students with United States’ colloquial English and commonly used slang and idioms could be helpful. These sessions could include faculty, staff, administrators, and community members. Such sessions could help enhance new international students’

English comprehension skills, oral proficiency, interpersonal relationship skills, and overall adaptation to life in the United States.

Considering that participants in this study reported challenges regarding securing off-campus housing and stayed in expensive hotels upon arrival, United States’ colleges and universities need to consider providing temporary shelter to international students, upon arrival. On-campus housing opportunities could offer proximity to classrooms, libraries, and other facilities. This proximity could reduce expenses and anxieties caused by commuting to and from off-campus housing. In addition, based on participants’ issues with unfamiliar foods, apartments would be ideal for international students because they would have an opportunity to cook their own familiar foods and use familiar recipes. In addition to housing opportunities, offering on-campus jobs to could help international students meet some of their financial obligations, including unanticipated expenses.

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Many international students come on visas that allow them to work part-time on their campuses (United States Citizenship and Immigration Services, 2016). On-campus jobs could help alleviate anxiety associated with searching for jobs off-campus, expenses associated with securing off-campus work permits, and stress associated with commuting to and from off-campus workplaces. These housing and job opportunities could provide another great opportunity for international students to interact with domestic students, faculty, and staff on a regular basis and ease their integration into the new culture. In addition, friendships could develop and alienation could decrease.

Implications for Counselor Educators and Other University Faculty

Given the influx of international students in United States’ colleges and universities (Institute of International Education, 2013) and cultural barriers that seem to impact adjustment experiences of many international students (Araujo, 2011; Mori,

2002), counselor educators and other university faculty should be encouraged to develop or enhance their multicultural competence. Even though multicultural competence standards, discussed in Chapter 1, were developed for mental health counselors (Sue et al., 1992), they are also applicable and relevant for faculty. These standards imply that faculty need to possess culture-specific knowledge about their students, be aware that cultural differences can be potential barriers to teaching, and develop skills applicable to working with students from diverse cultures. Nieto and Booth (2010) asserted that faculty awareness and interest in the culture of their international students could be helpful in understanding and helping international students academically and socially. I think a good starting point for faculty is to develop positive professional relationships

144 with their international students so that the students can open up and share their cultural background, cultural barriers that impede learning and adaptation, and catalysts to learning and social integration. A handful of simple things, discussed below, could help get the process in motion.

Faculty need to make serious efforts to know the general geographical locations of the countries where their international students come from. They could learn the names and proper pronunciation of the foreign names of their international students by writing down the names phonetically and then practice pronouncing them. They then need to address the international students by their actual names instead of asking students to provide alternative English names. Many international students may not have English names and may be forced to give themselves new names. It is important to understand that most of these students’ original names carry important cultural meanings and represent international students’ identities (Santa Clara County Office of Education,

2016). When these students are forced to drop these names, they may feel that faculty do not value or care about them or their culture.

In addition, faculty need to know their international students’ academic strengths and weaknesses, including English language proficiency. Faculty should not assume that lack of oral English language proficiency equates lack of written English language skills and lack of academic competence. Faculty should not overlook the fact that conversational competence tends to lag behind written language and academic competence (Genesee et al., 2006). Therefore, linguistic needs assessment should be conducted before any remedial or assistive programs and strategies are implemented

145 because language needs could be different between one international student and another, depending on whether English is used in their home country or not.

It is also important that faculty consider offering discipline-specific ESL seminars that supplement ESL courses to help their international students acquire relevant academic fundamentals rarely taught in regular ESL courses such as discipline-specific vocabulary, assessment strategies, and expectations for satisfactory performance. These seminars could even go beyond learning United States English and discipline-specific essentials and incorporate social topics that have been identified in literature as concerning for international students. Such topics could include classroom behavior expectations, interpersonal relationship skills, United States’ mores, and other United

States’ cultural practices. If developing such seminars is not practical, informal sessions hosted and facilitated by student organizations could be implemented. Other international students already in the various disciplines could be involved by offering support and sharing their own experiences and tips for academic and social success.

Results of this study also suggested that most participants faced challenges with

United States’ teaching methods. This implies that faculty should use differentiated instruction that provides different avenues to learning in order to accommodate students’ diverse learning needs and styles. Faculty should, therefore, anticipate and respond to students’ needs and learning styles by modifying the content (what is being taught), the process (how it is taught) and the product (how students demonstrate their learning), regardless of differences in ability or culture (Gregory & Chapman, 2002). In addition, reflecting on the teaching/learning process and then altering the delivery of instruction

146 according to the needs of their international students could also result in teaching that is more effective.

Based on participants’ difficulties with understanding culture-specific humor and examples to illustrate course content, it would be helpful for faculty to use culture-free humor and examples to ensure that their international students are not left out.

Furthermore, participants reported problems associated with impromptu questions asked by their professors during class. They reported feeling anxious due to lack of English language proficiency, different accent, perceived inadequacy in English, or fear of making mistakes while speaking English. It would be helpful if faculty consider giving more processing time to students who are linguistically diverse before they call upon them to give answers in class. Likewise, at the end of class, instead of asking students if they have questions on content presented, faculty could ask all students to write down questions they might have and submit them via email or other online platforms. At the beginning of the next class session, counselor educators could then read the questions to the class and provide answers or allow the class to share their thoughts and ideas in answer to the questions. Similarly, in addition to whole class discussion where international students are expected to share ideas and opinions in front of the whole class, including small group activities might produce less anxiety and promote talking.

Additionally, instead of giving extra credit for utilizing faculty office hours, faculty should explain the value of utilizing office hours, with the hope that students will be encouraged to utilize office hours. Faculty should explain the value of office hours, not only as a time for students to get extra assistance, but as an opportunity for both students

147 and faculty to get to know each other in an effort to develop professional relationships.

To accommodate students who find it uncomfortable to meet in private spaces, faculty could use time before and after class to meet with students in classrooms. These approaches could reduce international students’ anxiety and ensure equal learning opportunities for all students.

Regarding limited resources (basic, financial, and emotional needs), unfortunately, faculty may not be directly involved with providing resources to international students but they can show their solidarity by engaging in advocacy efforts on behalf of or alongside their international students. This can be done by volunteering to serve on committees that promote the welfare of international students or by initiating dialogues involving cross-cultural awareness and adjustment experiences of international students. Faculty could also advocate for fair policies regarding on-campus facilities and services.

Another issue suggested by results of this study was unfamiliarity with United

States mental health counseling. Since there tends to be regular contact between international students and faculty, it would be helpful for counselor educators to develop trusting relationships with these students, with the hope that international students might open up and share their problems. Such relationships could also facilitate conversations about the availability of on-campus support services, including counseling services. So, when faculty notice emotional, academic, or behavioral issues, it would be easier for them to encourage international students to seek help from relevant support services on

148 campus. This means faculty need to be knowledgeable about the various services and resources on campus and in the surrounding communities for them to make referrals.

Raising awareness of mental health services to international students might be via a blurb on their syllabi highlighting essential support services provided on campus, including location of service facilities, type of services offered, and contact persons. It is important for faculty to understand that even referrals to medical services could be effective since international students tend to perceive psychosomatic complaints as medical concerns (Mori, 2002) and tend to feel more comfortable seeking medical care services rather than mental health services (Nina, 2009; Onabule & Boes, 2013). These referrals could enable access to mental health services without facing the stigma that is often associated with reporting emotional or psychological problems.

Implications for Clinical Mental Health Counselors

As discussed in Chapter 1, the counseling profession has been focusing on the development of multiculturally competent counselors because the profession values cultural pluralism and social justice (ACA, 2014). Based on multicultural competence standards proposed by Sue et al. in 1992, counselors need to possess culture-specific knowledge about themselves and their clients, be aware that cultural differences can be potential barriers to counseling, and develop skills applicable to working with clients from diverse cultures. Counselors, therefore, need to make efforts to learn about or immerse themselves in diverse cultural groups as well as gain more knowledge about their own culture. The acquired knowledge can help counselors understand how their

149 own cultural backgrounds impact their work with international students and how international students’ cultural background informs their work.

In addition, counselors need to be familiar with and understand that international students face unique transition challenges that result in emotional, social and academic issues. Results of this study and many other previous studies discussed in Chapter 1

(e.g., Araujo, 2011; Constantine, Kindaichi, et al., 2005; Duru & Poyrazli, 2007; Mori,

2002; Sumer et al., 2008; Willis et al., 2003; Zhai, 2004) identified these challenges and their consequences. Regardless, many international students rarely seek counseling

(Mori, 2002) and for the few who do, early termination tends to result (Ahmed et al.,

2011; Araujo, 2011). Counselors need to understand that experience or familiarity with college counseling centers have a favorable influence on help-seeking attitudes. Based on results of this study, lack of exposure to and unfamiliarity with United States mental health counseling seemed to result in underutilization of counseling services. Therefore, counselors and their services should be visible during the induction week. This visibility could be ensured by counselors’ active participation in new international students’ orientation sessions, introducing counseling services, assisting with shedding positive light on mental health counseling, and debunking the stigma and other myths associated with seeking mental health services. Visibility could also be ensured by making on-campus counseling services known via college or university websites, newspapers, newsletters, e-bulletin boards, and flyers. Counselors also need to understand that counseling may undermine international students’ cultural beliefs and methods of resolving problems and it may be difficult for international students to accept mental

150 health services with which they may be unacquainted (Montreuil & Bourhis, 2001).

However, if these visibility efforts could continue after the induction week, awareness of counseling as a constructive and supportive process could increase, resulting in utilization of counseling services by international students.

Based on participants’ concerns about diagnoses, medication, privacy, and trust issues, psycho-education rather than counseling may be a favorable form of receiving help. Psycho-education aims to provide information and support so that individuals understand and accept their emotional problems and are empowered to cope with their problems in successful ways (Tursi, Baes, Camacho, Tofoli, & Juruena, 2013).

Psycho-education could be delivered in a group setting and content could be tailored to the needs of international students. For example, sessions could include delivery of information about the manifestation and prevention of common emotional problems faced by international students, skills training (such as communication, assertiveness, and social), and brainstorming of self-help strategies. Sessions could be interactive by using workbooks, handouts, videos, audiotapes, role plays, and computers. For the psycho-education to work effectively with international students, diagnosing should be avoided to reduce the stigma associated with seeking help. Given that participants in this study reported being self-reliant as they acclimated to life in the United States, psycho-education could meet with little or no resistance from international students. If individual counseling is an option, then solution-focused brief therapy (SFBT) might be effective.

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Considering that participants in this study reported resiliency and self-reliance as coping strategies, SFBT might be an acceptable form of problem resolution for international students. SFBT focuses on solution building rather than problem-solving, exploring current resources and future hopes, and finding tools they can use immediately to manage their symptoms and cope with challenges (Iveson, 2002). It views individuals as already possessing skills to resolve their own problems and to create change in their lives, but they often need help identifying and developing those skills (Iveson, 2002).

Using SFBT techniques, counselors could help international students develop a vision of their future by guiding them through the process of recognizing effective strategies, exploring how best to continue using those strategies, and encouraging them to acknowledge success. Even though SFBT might be effective, counselors should show cultural sensitivity and take into consideration international students’ beliefs and explanations about giving and receiving help.

Implications for Prospective and Current Zimbabwean International Students

Studying abroad is a major life decision that can be rewarding but it can come with challenges (Araujo, 2011). Careful long-term planning as well as conscious and intentional pre-departure preparation could be key to minimizing adjustment challenges.

It is important for prospective Zimbabwean international students to be proactive and to seek correct and updated information about the host culture and education system. For those who have access to computers, navigating the websites of their United States’ colleges or universities might be helpful. Those without access to computers can request that information be mailed to them. In both situations, phone calls could be made or

152 emails can be sent to the schools asking for clarification or more information. Having adequate knowledge about the host college or university might help Zimbabwean international students to adequately prepare for life in a new country and to have realistic expectations upon arrival. For example, when making travel plans, these international students could make inquiries about United States’ airport options and shuttle/taxi services from the airport to their campuses. In addition, students could inquire about and arrange temporary accommodation in advance, and consider lodgings that have kitchens or offer breakfast to minimize anxiety associated with looking for restaurants in an unfamiliar environment.

Based on the financial problems reported by participants in this study, it appeared as though they had underestimated the expenses associated with living in the United

States and lacked information about requirements for working in the United States.

Participants reported being interested in and willing to work in the United States to supplement their scholarships or savings. However, some of them realized that their visas did not permit them to work. It is, therefore, important for prospective

Zimbabwean international students to explore their funding options and establish their budget for their educational and living expenses well before they embark on their journey to study abroad. They, therefore, need to know that they cannot count on working in the

United States unless they have been granted a teaching/research assistantship or they have a visa that permits them to work. United States’ immigration regulations are very strict with respect to working while carrying a student visa (United States Citizenship and

Immigration Services, 2016). Currently, the F1 and J1 student visas allow for the

153 possibility of employment in the United States. Zimbabwean international students need to be familiar with the types of visas and make inquiries from their country’s United

States embassy or consulate about the criteria for obtaining these visas, type of jobs, and settings where they could work.

Based on their struggles with homesickness, loneliness, and limited social supports, it appeared as though participants understood the importance of remaining socially and emotionally connected and they stayed in touch with their families and friends in Zimbabwe. It is important, however, for current Zimbabwean international students to consider creating new support systems in their new and immediate environments. They need to open up to new people by taking the initiative to approach new people, ask to exchange contact information and follow up with a message or call, and invite others out for coffee or a simple meal. The other people would likely return the gesture, and friendships could develop. In addition, these international students need to get involved in the social aspects of their campuses by researching and joining student organizations and clubs that put them in constant contact with other students who share their interests. Furthermore, Zimbabwean international students need to open up to new experiences such as participating in social activities hosted by the office responsible for international student affairs, student government, student organizations, or communities around their campuses. Besides developing new support systems, such contacts and activities could help with social integration, including learning United States’ cultural values and practices.

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Finally, despite cultural differences regarding explanations and treatment of mental health problems, Zimbabwean international students need to give United States professional mental health counseling a chance. Given that they face numerous adjustment challenges and that their support systems are too far away to provide immediate help, these students should consider being open-minded about new experiences. They could start by making efforts to understand what counseling is, how it works, and then try it. They need to know that research has identified professional mental health counseling as an effective support system for international students

(Araujo, 2011; Nina, 2009).

Limitations of this Study

This study presented with two main limitations. First, the sample was not representative of all Zimbabwean international students studying in the United States.

For example, all participants reported being Shona and Christian and so other

Zimbabwean ethnic and religious groups were not represented. Gender was also not fairly represented; the study had three females and six males. In addition, the study had one undergraduate and eight graduate students. Sample representativeness could not be guaranteed due to the snowball sampling method I used to recruit participants. This method usually results in oversampling a particular network of peers, making it impossible to make inferences about populations based on the obtained sample (Noy,

2008). Therefore, results of this study should not be generalized to all Zimbabwean international students studying in the United States (a delimitation).

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Another limitation was possible researcher bias. I am Zimbabwean American and

I was born, raised, and went to school in Zimbabwe, from kindergarten to college. Just like participants in this study, I also came to the United States as an international student.

During interviews, I could relate to some of the adjustment experiences and perceptions of United States mental health counseling that participants shared. However, to minimize the possibilities of researcher bias and to safeguard my objectivity, I used the following strategies to ensure trustworthiness of this study: member checking, memos, reflexivity, peer reviews, and dissertation committee reviews.

Directions for Future Research

Future research should focus on adjustment experiences and perceptions of United

States mental health counseling of other ethnic groups in Zimbabwe in order to corroborate results of this study. Other research should compare data from males and females; undergraduate and graduate students; partnered and single students; students who grew up and went to school in rural areas and those who grew up and went to school in urban areas; and students with scholarships/assistantships and those who self-fund. It would also be interesting to compare data from students who were studying in different regions of the United States. Results of these data analyses could provide more insights likely to enhance services provided to international students from Zimbabwe.

Furthermore, future research could focus on identifying ways of increasing international students’ awareness and utilization of counseling services.

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Conclusion

The purpose of this study was to understand the adjustment experiences of

Zimbabwean international students as they study in the United States and to explore their perception of United States mental health counseling. The themes developed from the results suggested that participants: (a) faced adjustment challenges associated with limited resources (finances, housing, food, transportation, and social support); (b) navigated the United States’ academic environment to acquaint themselves with United

States’ teaching approaches, academic expectations, classroom behaviors, technology, and appropriate interactions with professors; (c) faced socio-cultural barriers ranging from the use of English language to general cultural practices; (d) had limited exposure to

United States mental health counseling and perceived cultural barriers to professional mental health counseling; and (e) acclimated to life in the United States by being self-reliant and utilizing informal social supports. As discussed earlier in this chapter and based on previous literature, participants’ adjustment experiences and perceptions of

United States mental health counseling were similar to those of international students from other countries. It appeared that cultural factors played a significant role in participants’ overall adjustment to life in the United States.

This study has contributed to the counseling profession by adding new knowledge to existing literature on adjustment experiences of international students and their perceptions of United States mental health counseling. The study has also provided higher education, counselor educators, and college counselors with new insights intended to develop viable programs and services likely to enable Zimbabwean international

157 students cope with challenges related to studying in a foreign country. In addition, this study has given a voice to Zimbabwe international students who shared and reflected on their adjustment experiences while studying in the United States and their perception of

United States mental health counseling. Furthermore, this study has provided helpful implications for prospective and current Zimbabwean international students, with great emphasis on the importance of careful and intentional pre-departure planning and preparation. It is my hope that conscious efforts are made to raise awareness about and identify the needs of international students. Such awareness could result in cultural sensitivity, rewarding learning experiences, and provision of appropriate resources and services for all international students.

APPENDICES

APPENDIX A

IRB APPROVAL FORM

Appendix A

IRB Approval Form

RE: IRB # 16-234 entitled “Adjustment experiences of Zimbabwean international students studying in the United States and their perception of the United States mental health counseling”

Hello, I am pleased to inform you that the Kent State University Institutional Review Board reviewed and approved your Application for Approval to Use Human Research Participants as a Level II/Expedited, category 6 & 7 project. Approval is effective for a twelve-month period: May 10, 2016 through May 9, 2017

*If applicable, a copy of the IRB approved consent form is attached to this email. This “stamped” copy is the consent form that you must use for your research participants. It is important for you to also keep an unstamped text copy (i.e., Microsoft Word version) of your consent form for subsequent submissions.

Federal regulations and Kent State University IRB policy require that research be reviewed at intervals appropriate to the degree of risk, but not less than once per year. The IRB has determined that this protocol requires an annual review and progress report. The IRB tries to send you annual review reminder notice by email as a courtesy. However, please note that it is the responsibility of the principal investigator to be aware of the study expiration date and submit the required materials. Please submit review materials (annual review form and copy of current consent form) one month prior to the expiration date. Visit our website for forms.

HHS regulations and Kent State University Institutional Review Board guidelines require that any changes in research methodology, protocol design, or principal investigator have the prior approval of the IRB before implementation and continuation of the protocol. The IRB must also be informed of any adverse events associated with the study. The IRB further requests a final report at the conclusion of the study.

Kent State University has a Federal Wide Assurance on file with the Office for Human Research Protections (OHRP); FWA Number 00001853.

If you have any questions or concerns, please contact the Office of Research Compliance at [email protected] or 330-672-2704 or 330-672-8058.

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APPENDIX B

RECRUITMENT LETTER

Appendix B

Recruitment Letter

Hello ______, I am a doctoral candidate at Kent State University, Ohio the purpose of my e-mail is to ask if you are willing to participate in my study entitled “Adjustment Experiences of Zimbabwean International Students in the United States and Their Perceptions of Professional Mental Health Counseling.” This study is part of the requirements of my degree in Counselor Education and Supervision. I would like to invite you to participate in my study.

I am attempting to understand the adjustment experiences of Zimbabwean international students studying in the United States and to explore their perceptions of United States mental health counseling. Results of the study are intended to contribute to the counseling profession by adding new knowledge to existing literature on mental health topics associated with international students and providing mental health professionals with new insights concerning effective multi- and cross-cultural work with diverse populations.

For this study, I am planning to interview Zimbabwean students who must meet the following criteria: 1. 18 years or older and currently studying in a United States’ college or university 2. Have been in the United States for at least one year 3. Lived in Zimbabwe for the majority of their lives 4. The United States is the only foreign country in which they have been a college or university student If you fit these eligibility requirements and you are willing to engage in this process, please, let me know within 2 weeks. You are under no obligation to participate and non-participation will not be held against you.

I am also requesting that you help me recruit more participants by forwarding this e-mail message or providing me with names and contact information of Zimbabwean students who you know, who are currently studying in the United States. If you are unable to participate or assist with recruiting potential participants, please let me know at your earliest convenience.

For more clarification or questions about the study, please contact me at 812- 236-4979 ([email protected]) or my faculty advisors, Dr. Jane A. Cox ([email protected]) and Dr. Lynne Guillot Miller ([email protected]).

I look forward to hearing from you and thank you for considering participation and helping with recruitment of more participants for my study. Sincerely,

Emily Mupinga, MS, NCC, PC

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APPENDIX C

INFORMED CONSENT LETTER TO PARTICIPANTS

Appendix C

Informed Consent Letter to Participants

1910·2010

Informed Consent Letter to Participants

Study Title: Adjustment Experiences of Zimbabwean International Students Studying in the United States and Their Perceptions of Professional Mental Health Counseling Principal Investigator: Jane A. Cox, Ph. D. Co-Investigator: Emily E. Mupinga, MS and Lynne Guillot Miller, Ph.D.

You are being invited to participate in a research study. This consent form will provide you with information on the research project, what you will need to do, and the associated risks and benefits of the research. Your participation is voluntary. Please read this form carefully. It is important that you ask questions and fully understand the research in order to make an informed decision. Please keep a copy of this document for your records.

Purpose The purpose of this study is to understand the meaning of adjustment experiences of Zimbabwean students as they study in the United States and to explore their perceptions of professional mental health counseling. Results of the study are intended to contribute to the counseling profession by adding new knowledge to existing literature on mental health topics associated with international students and providing mental health professionals with new insights concerning effective multi- and cross-cultural work with diverse populations, including Zimbabwean students.

Procedures When you agree to participate in this study, you will be asked to complete a demographics questionnaire and to participate in two interviews: The first interview will last approximately 45 to 90 minutes and the second interview will last 45 minutes, for a maximum total of 2 hours and 15 minutes. Interviews will take place at a mutually agreed upon day and time and they may be face-to-face, or telephone. Face-to-face interviews will be conducted in a private research carrel at a public library or in my office at Kent State University. Telephone interviews will be conducted from my office and you will be asked to be in a location that is private and free from distractions. Within two to four weeks of the initial interview, transcriptions and initial interpretations will be sent to you via e-mail for you to review. A second interview will be conducted approximately two weeks after you receive initial interpretations so that you give me feedback on whether or not interpretations accurately represent your adjustment experiences and perceptions of mental health counseling in the

164 165

United States. Please note that you will also spend approximately 1hour and 45 minutes to 2 hours and 45 minutes engaging in research related activities such as reading/responding to my emails and reviewing transcripts and interpretations (member checking). Please be sure to check your availability between the months of May 2016 and August 2016, before committing to this study. Your full participation should not exceed four months. If, for any reason, you choose to discontinue participation, you may do so at any time without incurring any penalty.

Benefits You will not benefit directly from participating in this study. However, the results may provide the counseling profession with a framework for developing viable counseling services and programs for diverse populations, particularly students from Zimbabwe.

Risks and Discomforts There are no anticipated risks beyond those encountered in everyday life. If you experience distress during or after the interviews, I would be happy to refer you to helpful resources.

Privacy and Confidentiality Confidentiality will be maintained within the limits of the law. This means I will not disclose your identifying information to anyone unless legally mandated. Audio tapes and transcripts will be kept in a locked cabinet in 404 White Hall at Kent State University and they will be destroyed at the conclusion of the study. Interview responses will be coded by pseudonyms to avoid having your name associated with the responses. Pseudonyms will also be used for the discussion and dissemination of the study’s findings at professional meetings and in publications.

Compensation When you consent to participate, you will receive a $10 gift card. The gift is an expression of my appreciation of you sharing your experiences with me.

Voluntary Participation Participation in this study is entirely voluntary. You may withdraw from the study at any time without consequences. You will be informed of any new, relevant information that may affect your health, welfare, or willingness to continue your study participation. You will be given a copy of this consent form for your own records when you agree to participate.

Contact Information If you have questions or concerns about this study, please contact me at 812- 236-4979 ([email protected]) or my faculty advisors, Dr. Jane A. Cox ([email protected]) and Dr. Lynne Guillot Miller ([email protected]).

166

This project has been approved by the Kent State University Institutional Review Board. If you have any questions about your rights as a research participant or complaints about the research, you may call the IRB at 330.672.2704.

Consent Statement and Signature I have read this consent form and have had the opportunity to have my questions answered to my satisfaction. I voluntarily agree to participate in this study. I understand consent was sent to me via email for future reference.

______Participant Signature Date

167

1910·2010

AUDIOTAPE CONSENT FORM

ADJUSTMENT EXPERIENCES OF ZIMBABWEAN INTERNATIONAL STUDENTS STUDYING IN THE UNITED STATES AND THEIR PERCEPTION OF UNITED STATES MENTAL HEALTH COUNSELING PRINCIPAL INVESTIGATOR: DR. JANE A. COX

I agree to participate in an audiotaped interview about the adjustment experiences of Zimbabwean international students studying in the United States and their perceptions of United States mental health counseling. I agree that Emily Mupinga may audiotape this interview. The date, time and place of the interview will be mutually agreed upon.

______Participant Signature Date

I have been told that I have the right to listen to the recording of the interview before it is used. I have decided that I:

want to listen to the recording __do not want to listen to the recording

Sign now below if you do not want to listen to the recording. If you want to listen to the recording, you will be asked to sign after listening to them.

Emily Mupinga may I may not (circle one) use the audiotapes made of me. The original tapes or copies may be used for:

____this research project __publication __ presentation at professional meetings

______Participant Signature Date

APPENDIX D

DEMOGRAPHICS QUESTIONNAIRE

Appendix D

Demographics Questionnaire

Participant’s Pseudonym: ______

Date: ______

Instructions: Please answer all of the following questions as they describe you. Your answers will be used for research purposes only and will be kept strictly confidential.

1. What is your age? ______

2. What is your sex? ______

3. What is your partner status? ______

a. If you are partnered, is your partner with you here in the United States?

______

4. If you have children, are they with you here in the United States? ______

5. What is your primary language? ______

6. What level of education are you pursuing (undergraduate or graduate)?

______

7. How long have you been studying in the United States? ______

8. What is your religious affiliation? ______

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APPENDIX E

FIRST INTERVIEW QUESTIONS

Appendix E

First Interview Questions

During this first interview, I will be asking you to share your adjustment experiences as an international student studying in the United States and your perception of professional mental health counseling. Please, let me know if you feel uncomfortable answering any of the questions I will ask you.

1. Please share your experiences of adjusting to life while studying in the

United States.

2. Often, here in the United States, when people encounter social, emotional,

or academic problems, they seek the help of professional helpers.

i. Have you sought professional mental health counseling while

studying in the United States? (If answer is “Yes,” ask questions ii;

if answer is “No,” skip questions ii and ask questions iii)

ii. What type of problems did you present?

a) Did you have any problems that you were not comfortable

sharing with a professional counselor?

b) Do you mind telling me more about these problems?

c) What are other ways that you use to resolve or cope with

problems?

iii. If you did not/do not seek the help of professional counselors, how

do you resolve or cope with your problems?

What are your perceptions of United States mental health counseling?

171

APPENDIX F

SECOND INTERVIEW QUESTIONS

Appendix F

Second Interview Questions

Thank you so much for agreeing to provide feedback of the review you did on the initial interpretations of your adjustment experiences and perceptions of professional mental health counseling. Please, let me know if you feel uncomfortable answering any of the questions I will ask you.

1. Are the transcripts and my initial interpretation congruent with your adjustment

experiences and perceptions of professional mental health counseling?

2. Have any of your adjustment experiences and perceptions of professional mental

health counseling been omitted?

3. What other additional adjustment experiences and perceptions would you like to

share?

4. Share your thoughts and comments on the interpretation of the data.

173

APPENDIX G

AUDIO RECODINGS

Appendix G

Audio Recordings

Audio Recording

The audio tapes will be destroyed after transcription and analysis of data. All information obtained from you (identifying and interview information) will also be shredded when the research study is completed. Please check one:

_____ I give permission for the audio recording to be used as described above.

_____ I DO NOT give permission for the audio recording to be used as described above.

175

APPENDIX H

MEMBER CHECKING LETTER

Appendix H

Member Checking Email

Hello ------,

Thank you once again for participating in my study. I am requesting you to review the attached documents to verify if transcripts and my initial interpretation are congruent with your adjustment experiences and perceptions of United States mental health counseling. We will discuss your feedback during our second meeting scheduled in about

2 weeks.

Thank you.

Emily Mupinga

177

APPENDIX I

PEER REVIEWER LETTER

Appendix I

Peer Reviewer Letter

Hello ______,

Thank you so much for agreeing to be a peer reviewer for my research study. After interviews are transcribed and data are coded, I will request that you review codes and themes to check for inconsistencies and discrepancies such as over- and underemphasized points, vague descriptions, or biases. I will also request that you provide feedback and suggestions to ensure that transcriptions and themes are congruent.

By signing this consent form, you acknowledge your understanding of the participants’ rights to privacy and you agree to keep all knowledge of the interviews confidential. Participants’ names will not be released to you; only the participants’ code will be used as an identifier in this process. To protect your rights and privacy this consent form will be kept in a locked file in 405 White Hall, Kent State University, Kent Ohio, 44242. You will receive a copy of this consent form.

If you want to know more about peer reviewing, in relation to this study, please call me at (812) 236-4979.

Sincerely,

Emily E. Mupinga, MS, NCC, PC

CONSENT STATEMENT I agree to abide by the privacy and confidentiality regulations set forth by the Kent State University Institutional Review Board. I understand my role as a peer reviewer in this study, and if I violate the privacy or confidentiality of any participant in this study I will be reported to the Kent State Institutional Review Board.

Peer Reviewer’s Printed Name: ______

Signature: ______Date: ______

Investigator’s Signature: ______Date: ______

179

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